Provider Demographics
NPI:1841329695
Name:WYLIE, JESSICA RAE
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RAE
Last Name:WYLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:RAE
Other - Last Name:BEAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1026 DENMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2575
Mailing Address - Country:US
Mailing Address - Phone:740-502-9281
Mailing Address - Fax:
Practice Address - Street 1:1026 DENMAN AVE
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2575
Practice Address - Country:US
Practice Address - Phone:740-502-9281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2539391Medicaid