Provider Demographics
NPI:1457240715
Name:JESSEN, ALICE (RPRS)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:JESSEN
Suffix:
Gender:F
Credentials:RPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 BELMEADE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2002
Mailing Address - Country:US
Mailing Address - Phone:423-963-2990
Mailing Address - Fax:423-963-2990
Practice Address - Street 1:261 NORTH ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3275
Practice Address - Country:US
Practice Address - Phone:423-518-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0735001337175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist