Provider Demographics
NPI:1609486489
Name:LAFFERTY, JESSIE
Entity Type:Individual
Prefix:MR
First Name:JESSIE
Middle Name:
Last Name:LAFFERTY
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 1:18 BARKWOOD LN # LM
Mailing Address - Street 2:
Mailing Address - City:JULIAN
Mailing Address - State:WV
Mailing Address - Zip Code:25529-9753
Mailing Address - Country:US
Mailing Address - Phone:304-369-4995
Mailing Address - Fax:
Practice Address - Street 1:128 EDGEHILL RD
Practice Address - Street 2:
Practice Address - City:JULIAN
Practice Address - State:WV
Practice Address - Zip Code:25529-9384
Practice Address - Country:US
Practice Address - Phone:304-307-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant