Provider Demographics
NPI:1457727281
Name:VALESKO, JESSICA (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VALESKO
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 1:3158 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4637
Mailing Address - Country:US
Mailing Address - Phone:304-797-7733
Mailing Address - Fax:
Practice Address - Street 1:1151 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWELL
Practice Address - State:WV
Practice Address - Zip Code:26050-1437
Practice Address - Country:US
Practice Address - Phone:304-459-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17770-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810029921Medicaid
OH0141559Medicaid
OHH427340Medicare PIN