Provider Demographics
NPI:1720408982
Name:DARNELL, JESSICA (LMP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DARNELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73673
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0673
Mailing Address - Country:US
Mailing Address - Phone:253-754-2826
Mailing Address - Fax:
Practice Address - Street 1:1720 3RD ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4505
Practice Address - Country:US
Practice Address - Phone:253-904-8954
Practice Address - Fax:253-445-4480
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60280602225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist