Provider Demographics
NPI:1477238186
Name:HAYCRAFT, JESSICA ELLEN JOHNSON (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELLEN JOHNSON
Last Name:HAYCRAFT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BOBBY BLAND WAY
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1744
Mailing Address - Country:US
Mailing Address - Phone:270-259-0500
Mailing Address - Fax:
Practice Address - Street 1:31 BOBBY BLAND WAY
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1744
Practice Address - Country:US
Practice Address - Phone:270-259-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2325DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist