Provider Demographics
NPI:1598266520
Name:MEADE, JESSE ROY
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ROY
Last Name:MEADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SURPRISE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-8538
Mailing Address - Country:US
Mailing Address - Phone:304-237-1393
Mailing Address - Fax:
Practice Address - Street 1:1000 VERMILLION ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:WV
Practice Address - Zip Code:24712-9027
Practice Address - Country:US
Practice Address - Phone:304-237-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer