Provider Demographics
NPI:1487351789
Name:HAYWOOD, JESSIE FRANCES (RN)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:FRANCES
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:FRANCES
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JESSIE WALTON
Mailing Address - Street 1:739 DRY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AU SABLE FORKS
Mailing Address - State:NY
Mailing Address - Zip Code:12912-3103
Mailing Address - Country:US
Mailing Address - Phone:518-524-5734
Mailing Address - Fax:
Practice Address - Street 1:2155 NY-22B
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962
Practice Address - Country:US
Practice Address - Phone:518-563-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY685040-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse