Provider Demographics
NPI:1346261013
Name:ICE, JESSICA B (PA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:B
Last Name:ICE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40008
Mailing Address - Country:US
Mailing Address - Phone:502-252-5081
Mailing Address - Fax:502-252-7211
Practice Address - Street 1:107 PERRY ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:KY
Practice Address - Zip Code:40008
Practice Address - Country:US
Practice Address - Phone:502-252-5081
Practice Address - Fax:502-252-7211
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant