Provider Demographics
NPI:1104439298
Name:GRIFFIN, JESSICA DAWN (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:GRIFFIN
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 1:1526 DOE RUN
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:WV
Mailing Address - Zip Code:26456-6009
Mailing Address - Country:US
Mailing Address - Phone:304-483-3507
Mailing Address - Fax:
Practice Address - Street 1:521 SOUTH COURT STREET
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362
Practice Address - Country:US
Practice Address - Phone:304-643-4941
Practice Address - Fax:304-643-4936
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV79874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse