Provider Demographics
NPI:1457901936
Name:LEMOINE, JESSICA JO JOYCE (LVN)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:JO JOYCE
Last Name:LEMOINE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E BRAZOS ST
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-1410
Mailing Address - Country:US
Mailing Address - Phone:254-747-0987
Mailing Address - Fax:
Practice Address - Street 1:310 E BRAZOS ST
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-1410
Practice Address - Country:US
Practice Address - Phone:254-747-0987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350312164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse