Provider Demographics
NPI:1124617394
Name:BEEBE, JESSICA RENAE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENAE
Last Name:BEEBE
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 1:107 1/2 CLARKSBURG ST
Mailing Address - Street 2:
Mailing Address - City:MANNINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26582-1354
Mailing Address - Country:US
Mailing Address - Phone:304-694-2427
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:503 MORGANTOWN AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4388
Practice Address - Country:US
Practice Address - Phone:304-363-7375
Practice Address - Fax:304-363-7376
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker