Provider Demographics
NPI:1386255149
Name:MAUPIN, JESSICA ANN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 WINCHESTER AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7645
Mailing Address - Country:US
Mailing Address - Phone:606-722-0486
Mailing Address - Fax:606-777-7937
Practice Address - Street 1:1557 WINCHESTER AVE STE 207
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7645
Practice Address - Country:US
Practice Address - Phone:606-722-0486
Practice Address - Fax:606-777-7937
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1148438163W00000X
WV113533363LP0808X
KY3017912363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse