Provider Demographics
NPI:1801100508
Name:NEW, JESSICA CHERRON (PTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CHERRON
Last Name:NEW
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:PARKER CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47368-9303
Mailing Address - Country:US
Mailing Address - Phone:765-625-1628
Mailing Address - Fax:
Practice Address - Street 1:2225 N 1000 W
Practice Address - Street 2:
Practice Address - City:PARKER CITY
Practice Address - State:IN
Practice Address - Zip Code:47368-9303
Practice Address - Country:US
Practice Address - Phone:765-625-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003580A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility