Provider Demographics
NPI:1386367266
Name:SHOTT, JESSICA (LPN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SHOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12514-2649
Mailing Address - Country:US
Mailing Address - Phone:845-240-6746
Mailing Address - Fax:
Practice Address - Street 1:88 FOX HOLLOW RD
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3639
Practice Address - Country:US
Practice Address - Phone:845-647-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303381164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse