Provider Demographics
NPI:1568105971
Name:CLINE, JESSICA D
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:CLINE
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:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-0441
Mailing Address - Country:US
Mailing Address - Phone:304-946-1713
Mailing Address - Fax:
Practice Address - Street 1:100 MCARTHUR AVE
Practice Address - Street 2:
Practice Address - City:LYNCO
Practice Address - State:WV
Practice Address - Zip Code:24857
Practice Address - Country:US
Practice Address - Phone:304-946-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33894364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health