Provider Demographics
NPI:1275649097
Name:JESSA, PEACE NNENNAYA (DO)
Entity Type:Individual
Prefix:
First Name:PEACE
Middle Name:NNENNAYA
Last Name:JESSA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 HICKSWOOD RD STE 106
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1538
Mailing Address - Country:US
Mailing Address - Phone:336-885-9675
Mailing Address - Fax:336-885-9682
Practice Address - Street 1:2401 HICKSWOOD RD STE 106
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1538
Practice Address - Country:US
Practice Address - Phone:336-885-9675
Practice Address - Fax:336-885-9682
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC017372083P0500X
OH34.0105802083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK010471Medicare PIN
KY64121171Medicaid
KY000000736993OtherANTHEM