Provider Demographics
NPI:1619342599
Name:RICE, JESSICA L (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:RICE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:29 HOSPITAL PLZ STE C
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8471
Mailing Address - Country:US
Mailing Address - Phone:304-269-4431
Mailing Address - Fax:304-269-9803
Practice Address - Street 1:29 HOSPITAL PLZ STE C
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8471
Practice Address - Country:US
Practice Address - Phone:304-269-4431
Practice Address - Fax:304-269-9803
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV82929363LF0000X
WVAPRN82920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily