Provider Demographics
NPI:1891413209
Name:WESTPHAL, JESSICA DAWN UNDERWOOD (COA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DAWN UNDERWOOD
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:COA
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:DAWN
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COA
Mailing Address - Street 1:300 LONG SHOALS RD APT 12D
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7755
Mailing Address - Country:US
Mailing Address - Phone:828-490-0035
Mailing Address - Fax:
Practice Address - Street 1:1100 TUNNEL RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2576
Practice Address - Country:US
Practice Address - Phone:828-298-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic