Provider Demographics
NPI:1467897900
Name:MCCAIN, JESSICA R (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3366
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3366
Mailing Address - Country:US
Mailing Address - Phone:812-867-8991
Mailing Address - Fax:812-867-8995
Practice Address - Street 1:15814 NEELEY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-8420
Practice Address - Country:US
Practice Address - Phone:812-867-8991
Practice Address - Fax:812-867-8995
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALDO.1506207R00000X
IN02004957A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program