Provider Demographics
NPI:1255187514
Name:KISER, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KISER
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 1:5489 KY ROUTE 680 APT 2
Mailing Address - Street 2:
Mailing Address - City:GRETHEL
Mailing Address - State:KY
Mailing Address - Zip Code:41631-9081
Mailing Address - Country:US
Mailing Address - Phone:606-477-3789
Mailing Address - Fax:
Practice Address - Street 1:5489 KY ROUTE 680 APT 2
Practice Address - Street 2:
Practice Address - City:GRETHEL
Practice Address - State:KY
Practice Address - Zip Code:41631-9081
Practice Address - Country:US
Practice Address - Phone:606-477-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR03876504222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist