Provider Demographics
NPI:1407470172
Name:MILLIKEN, JESSIE (DO)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:MILLIKEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 VANDERBILT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-6241
Mailing Address - Country:US
Mailing Address - Phone:724-628-3944
Mailing Address - Fax:724-603-3090
Practice Address - Street 1:854 VANDERBILT RD STE 1
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-6241
Practice Address - Country:US
Practice Address - Phone:724-628-3944
Practice Address - Fax:724-603-3090
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine