Provider Demographics
NPI:1093851248
Name:SUTHERLAND, JESSICA (BS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BIG RIDGE ROAD
Mailing Address - Street 2:P.O. 405
Mailing Address - City:HAYSI
Mailing Address - State:VA
Mailing Address - Zip Code:24256-0405
Mailing Address - Country:US
Mailing Address - Phone:276-835-8979
Mailing Address - Fax:
Practice Address - Street 1:133 MCCLURE AVE
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-0309
Practice Address - Country:US
Practice Address - Phone:276-926-1680
Practice Address - Fax:276-926-9179
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator