Provider Demographics
NPI:1871261719
Name:NOLAN, JESSICA KAY
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAY
Last Name:NOLAN
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 1:103 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8663
Mailing Address - Country:US
Mailing Address - Phone:740-645-6804
Mailing Address - Fax:
Practice Address - Street 1:103 HAZEL ST
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-8663
Practice Address - Country:US
Practice Address - Phone:740-645-6804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide