Provider Demographics
NPI:1508245358
Name:GARRETT, JESIKA (LPN)
Entity Type:Individual
Prefix:
First Name:JESIKA
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JESIKA
Other - Middle Name:
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:109 AIRPORT PLACE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:SD
Mailing Address - Zip Code:57720-0103
Mailing Address - Country:US
Mailing Address - Phone:605-200-9110
Mailing Address - Fax:
Practice Address - Street 1:109 AIRPORT PLACE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:SD
Practice Address - Zip Code:57720-0103
Practice Address - Country:US
Practice Address - Phone:605-200-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDP011510164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse