Provider Demographics
NPI:1942677943
Name:MYERS, JESSIE LEE (FNP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:LEE
Last Name:MYERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:LEE
Other - Last Name:FARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:315 W OLD KEY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-9001
Mailing Address - Country:US
Mailing Address - Phone:765-475-6963
Mailing Address - Fax:
Practice Address - Street 1:315 W OLD KEY DR STE 150
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-9001
Practice Address - Country:US
Practice Address - Phone:765-475-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005750A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily