Provider Demographics
NPI:1558003376
Name:PERRY, JESSICA LOUISE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17348 ROUTE 152
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:WV
Mailing Address - Zip Code:25517-7514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17348 ROUTE 152
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:WV
Practice Address - Zip Code:25517-7514
Practice Address - Country:US
Practice Address - Phone:304-453-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant