Provider Demographics
NPI:1194311837
Name:EDWARDS, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EDWARDS
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 1:6655 WESTFALL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-9244
Mailing Address - Country:US
Mailing Address - Phone:937-621-5163
Mailing Address - Fax:
Practice Address - Street 1:109 W NORTH ST
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:OH
Practice Address - Zip Code:45359-8042
Practice Address - Country:US
Practice Address - Phone:937-621-5163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide