Provider Demographics
NPI:1366195190
Name:SKAGGS, JESSICA ANN (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:SKAGGS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:SAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 S JACKSON ST FL 3
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3229
Practice Address - Country:US
Practice Address - Phone:502-561-7220
Practice Address - Fax:502-588-9529
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016741363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty