Provider Demographics
NPI:1386304202
Name:BIBB, JESSA CLAIRE
Entity type:Individual
Prefix:
First Name:JESSA
Middle Name:CLAIRE
Last Name:BIBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 HOLLY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3617
Mailing Address - Country:US
Mailing Address - Phone:901-389-8601
Mailing Address - Fax:
Practice Address - Street 1:6697 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3867
Practice Address - Country:US
Practice Address - Phone:901-373-6498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000044595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist