Provider Demographics
NPI:1508235201
Name:SCRUGGS, JESSICA BRIGHT (NP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:BRIGHT
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:NP
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 297
Mailing Address - Street 2:200 POCAHONTAS TRIAL
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0297
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:919 S CRAIG AVE
Practice Address - Street 2:SUITE A
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1954
Practice Address - Country:US
Practice Address - Phone:540-960-2231
Practice Address - Fax:540-960-2245
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508235201Medicaid
VAVVJ879E984Medicare PIN