Provider Demographics
NPI:1154034064
Name:EDWARDS, JESSICA (CNA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 SPRING MEADOW LN APT 201
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-2494
Mailing Address - Country:US
Mailing Address - Phone:540-222-0730
Mailing Address - Fax:
Practice Address - Street 1:1313 SPRING MEADOW LN APT 201
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2494
Practice Address - Country:US
Practice Address - Phone:540-222-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401199306376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty