Provider Demographics
NPI:1336563089
Name:STEWARD, JESSICA (CRNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STEWARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SULSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:11 HUNT CLUB PLZ
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-5213
Mailing Address - Country:US
Mailing Address - Phone:304-726-4501
Mailing Address - Fax:304-726-4051
Practice Address - Street 1:11 HUNT CLUB PLZ
Practice Address - Street 2:
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753-5213
Practice Address - Country:US
Practice Address - Phone:304-726-4501
Practice Address - Fax:304-726-4051
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171518363LF0000X
WV60850363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily