Provider Demographics
NPI:1477949956
Name:ISON, JESSICA ELISABETH (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELISABETH
Last Name:ISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ELISABETH
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 N MAYSVILLE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1179
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:
Practice Address - Street 1:209 N MAYSVILLE ST STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1179
Practice Address - Country:US
Practice Address - Phone:859-404-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52585207Q00000X, 207VX0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
14499852OtherCAQH ID NUMBER
KY52585OtherKY LICENSE NUMBER
KYFI6918049OtherDEA NUMBER