Provider Demographics
NPI:1285063511
Name:PERDUE, JESSICA MICHELLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:PERDUE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 COUNTY ROAD 411
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-9404
Mailing Address - Country:US
Mailing Address - Phone:740-451-0511
Mailing Address - Fax:740-451-0605
Practice Address - Street 1:347 COUNTY ROAD 411
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-9404
Practice Address - Country:US
Practice Address - Phone:740-451-0511
Practice Address - Fax:740-451-0605
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty