Provider Demographics
NPI:1669775235
Name:TESTER, JESSICA LEA (RN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEA
Last Name:TESTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3445
Mailing Address - Country:US
Mailing Address - Phone:423-647-3323
Mailing Address - Fax:
Practice Address - Street 1:219 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2052
Practice Address - Country:US
Practice Address - Phone:423-975-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000170968163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health