Provider Demographics
NPI:1467859223
Name:WILLS, JESSICA A (CNA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:WILLS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:SNUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:1175 MOUNT VIEW RD
Mailing Address - Street 2:
Mailing Address - City:COOL RIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25825-9520
Mailing Address - Country:US
Mailing Address - Phone:304-222-6443
Mailing Address - Fax:
Practice Address - Street 1:1175 MOUNT VIEW RD
Practice Address - Street 2:
Practice Address - City:COOL RIDGE
Practice Address - State:WV
Practice Address - Zip Code:25825-9520
Practice Address - Country:US
Practice Address - Phone:304-222-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0810-59899376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide