Provider Demographics
NPI:1215478136
Name:HUCKINS, JESSICA LEE (RNFA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:HUCKINS
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5770
Mailing Address - Country:US
Mailing Address - Phone:307-299-7006
Mailing Address - Fax:
Practice Address - Street 1:203 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5770
Practice Address - Country:US
Practice Address - Phone:307-299-7006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY23136163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant