Provider Demographics
NPI:1972215226
Name:STATON, JESSICA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:STATON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6347 COONEY RD
Mailing Address - Street 2:
Mailing Address - City:DELTON
Mailing Address - State:MI
Mailing Address - Zip Code:49046-7751
Mailing Address - Country:US
Mailing Address - Phone:269-598-1810
Mailing Address - Fax:
Practice Address - Street 1:8653 N 32ND ST STE 1C
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-9494
Practice Address - Country:US
Practice Address - Phone:269-225-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily