Provider Demographics
NPI:1063108009
Name:ROSS, JESSICA RAE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697-9499
Mailing Address - Country:US
Mailing Address - Phone:937-798-9979
Mailing Address - Fax:
Practice Address - Street 1:10 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45697-9499
Practice Address - Country:US
Practice Address - Phone:937-798-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
402137840119374U00000X
OH402137840119376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide