Provider Demographics
NPI:1598487142
Name:JARRELL, SISSY MARIE
Entity Type:Individual
Prefix:
First Name:SISSY
Middle Name:MARIE
Last Name:JARRELL
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 1:16 T AND T LN
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-9368
Mailing Address - Country:US
Mailing Address - Phone:681-264-1314
Mailing Address - Fax:
Practice Address - Street 1:16 T AND T LN
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-9368
Practice Address - Country:US
Practice Address - Phone:681-264-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant