Provider Demographics
NPI:1609574490
Name:HESSON, JOHN RICHARD JR (LPN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:HESSON
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 CLOVERDALE LN
Mailing Address - Street 2:
Mailing Address - City:APPLE GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:25502-8084
Mailing Address - Country:US
Mailing Address - Phone:304-812-1069
Mailing Address - Fax:
Practice Address - Street 1:2410 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1528
Practice Address - Country:US
Practice Address - Phone:304-675-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29152164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse