Provider Demographics
NPI:1235367335
Name:MCCOLLEY, JESSICA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:MCCOLLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:104 ALEX LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2952
Mailing Address - Country:US
Mailing Address - Phone:304-734-2040
Mailing Address - Fax:304-734-2047
Practice Address - Street 1:1 WARRIOR WAY
Practice Address - Street 2:
Practice Address - City:BELLE
Practice Address - State:WV
Practice Address - Zip Code:25015-1356
Practice Address - Country:US
Practice Address - Phone:304-949-3591
Practice Address - Fax:304-949-3791
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2020-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV2800207Q00000X
VA0116021857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine