Provider Demographics
NPI:1629311154
Name:HALL, JESSICA ANNETTE (CNA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANNETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:ANNETTE
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 E PALESTINE AVE
Mailing Address - Street 2:F23
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4835
Mailing Address - Country:US
Mailing Address - Phone:615-997-4641
Mailing Address - Fax:
Practice Address - Street 1:1116 LAMONT CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4715
Practice Address - Country:US
Practice Address - Phone:615-997-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN001586333747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant