Provider Demographics
NPI:1740891910
Name:EALEY, JESSICA CELESTE (CNA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CELESTE
Last Name:EALEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 WATSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KINSEY
Mailing Address - State:AL
Mailing Address - Zip Code:36303-7629
Mailing Address - Country:US
Mailing Address - Phone:334-618-2550
Mailing Address - Fax:
Practice Address - Street 1:271 WATSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:KINSEY
Practice Address - State:AL
Practice Address - Zip Code:36303-7629
Practice Address - Country:US
Practice Address - Phone:334-618-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health