Provider Demographics
NPI:1376323204
Name:WARD, JESSICA (CPT 1)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:CPT 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CHEROKEE DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-1619
Mailing Address - Country:US
Mailing Address - Phone:833-768-3463
Mailing Address - Fax:
Practice Address - Street 1:605 CHEROKEE DR UNIT 2
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-1619
Practice Address - Country:US
Practice Address - Phone:833-768-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01014591246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy