Provider Demographics
NPI:1285873919
Name:THIESSEN LONG, JESSICA RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RUTH
Last Name:THIESSEN LONG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:L-3401
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-3401
Mailing Address - Country:US
Mailing Address - Phone:740-615-1324
Mailing Address - Fax:740-615-1344
Practice Address - Street 1:100 TIPPETT CT
Practice Address - Street 2:SUITE 101
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-8572
Practice Address - Country:US
Practice Address - Phone:740-965-3123
Practice Address - Fax:740-965-9713
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2022-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.095047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3144869Medicaid
H001490Medicare PIN