Provider Demographics
NPI:1639630825
Name:KULP, JESSICA ERIN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:KULP
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 1:441 POMFRET RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05084-9703
Mailing Address - Country:US
Mailing Address - Phone:802-299-0509
Mailing Address - Fax:
Practice Address - Street 1:441 POMFRET RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:VT
Practice Address - Zip Code:05084-9703
Practice Address - Country:US
Practice Address - Phone:802-299-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH065313-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse