Provider Demographics
NPI:1346913241
Name:BURRIS, JESSICA NICHOLE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICHOLE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 GEORGE ST.
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:WV
Mailing Address - Zip Code:25260
Mailing Address - Country:US
Mailing Address - Phone:304-514-3628
Mailing Address - Fax:
Practice Address - Street 1:289 GEORGE ST.
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:WV
Practice Address - Zip Code:25260
Practice Address - Country:US
Practice Address - Phone:304-514-3628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant