Provider Demographics
NPI:1982097051
Name:DARNELL, JESSICA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:DARNELL
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:PO BOX 870752
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-0752
Mailing Address - Country:US
Mailing Address - Phone:907-376-2522
Mailing Address - Fax:
Practice Address - Street 1:5161 W STACY ST
Practice Address - Street 2:LOT 343
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-4167
Practice Address - Country:US
Practice Address - Phone:907-376-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK29245163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse