Provider Demographics
NPI:1851769764
Name:POE, JESSICA NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:POE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SACKETT DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1547
Mailing Address - Country:US
Mailing Address - Phone:513-320-1881
Mailing Address - Fax:513-672-2310
Practice Address - Street 1:140 SACKETT DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-1547
Practice Address - Country:US
Practice Address - Phone:513-320-1881
Practice Address - Fax:513-672-2310
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18141363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000965284OtherANTHEM
OH0144993Medicaid
OH0144993Medicaid