Provider Demographics
NPI:1134907108
Name:BROWN, JESSICA (CPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:AFFORDABLE
Other - Middle Name:MOBILE
Other - Last Name:PHLEBOTOMY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4521 CRAWFORDSVILLE CAMPBELLSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9677
Mailing Address - Country:US
Mailing Address - Phone:937-605-2640
Mailing Address - Fax:
Practice Address - Street 1:2999 CARMODY BOULEVARD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042
Practice Address - Country:US
Practice Address - Phone:937-605-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHQ5R7B4K6246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy