Provider Demographics
NPI:1285199042
Name:HUBBS, JESSIE
Entity Type:Individual
Prefix:MR
First Name:JESSIE
Middle Name:
Last Name:HUBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 SOMEDAY LN
Mailing Address - Street 2:
Mailing Address - City:MONTREAL
Mailing Address - State:MO
Mailing Address - Zip Code:65591-5100
Mailing Address - Country:US
Mailing Address - Phone:417-861-1639
Mailing Address - Fax:
Practice Address - Street 1:901 S NATIONAL AVE # 160
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897-0027
Practice Address - Country:US
Practice Address - Phone:417-836-8553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program