Provider Demographics
NPI:1093259343
Name:WEISS, JESSIE KENNEDY
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:KENNEDY
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 1ST ST NE APT 308
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4699
Mailing Address - Country:US
Mailing Address - Phone:202-615-1078
Mailing Address - Fax:
Practice Address - Street 1:1160 1ST ST NE APT 308
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4699
Practice Address - Country:US
Practice Address - Phone:202-615-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty