Provider Demographics
NPI:1083023451
Name:RICHMOND, JESSI ELLEN (ARNP FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JESSI
Middle Name:ELLEN
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:ARNP FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:IA
Mailing Address - Zip Code:52645-1329
Mailing Address - Country:US
Mailing Address - Phone:319-367-2241
Mailing Address - Fax:
Practice Address - Street 1:111 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:IA
Practice Address - Zip Code:52645-1329
Practice Address - Country:US
Practice Address - Phone:319-367-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA119738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily