Provider Demographics
NPI:1497265656
Name:MULLINS, JESSICA PAIGE (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:PAIGE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 STATE ROUTE 784
Mailing Address - Street 2:
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175-9785
Mailing Address - Country:US
Mailing Address - Phone:606-932-2060
Mailing Address - Fax:
Practice Address - Street 1:37 STATE ROUTE 784
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175-9785
Practice Address - Country:US
Practice Address - Phone:606-932-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide