Provider Demographics
NPI:1306625777
Name:WEATHERSBY, JESSICA (STNA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WEATHERSBY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7245 CLOVERNOOK AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5520
Mailing Address - Country:US
Mailing Address - Phone:513-266-8299
Mailing Address - Fax:
Practice Address - Street 1:7245 CLOVERNOOK AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-5520
Practice Address - Country:US
Practice Address - Phone:513-266-8299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide