Provider Demographics
NPI:1861029811
Name:MYERS, JESSICA (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27300 BRUSSO FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:FL
Mailing Address - Zip Code:32046-5237
Mailing Address - Country:US
Mailing Address - Phone:919-478-6651
Mailing Address - Fax:
Practice Address - Street 1:27300 BRUSSO FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:FL
Practice Address - Zip Code:32046-5237
Practice Address - Country:US
Practice Address - Phone:919-478-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
AL63862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program