Provider Demographics
NPI:1639931066
Name:DUPREE, JESHONDA M
Entity Type:Individual
Prefix:
First Name:JESHONDA
Middle Name:M
Last Name:DUPREE
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 1:4960 REUNION DR
Mailing Address - Street 2:
Mailing Address - City:WALLS
Mailing Address - State:MS
Mailing Address - Zip Code:38680-1001
Mailing Address - Country:US
Mailing Address - Phone:314-443-8919
Mailing Address - Fax:
Practice Address - Street 1:4960 REUNION DR
Practice Address - Street 2:
Practice Address - City:WALLS
Practice Address - State:MS
Practice Address - Zip Code:38680-1001
Practice Address - Country:US
Practice Address - Phone:314-443-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider