Provider Demographics
NPI:1588350136
Name:GEE, JESSICA BAILEY
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BAILEY
Last Name:GEE
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 1:2434 ALDER ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-4328
Mailing Address - Country:US
Mailing Address - Phone:757-450-5654
Mailing Address - Fax:
Practice Address - Street 1:2434 ALDER ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-4328
Practice Address - Country:US
Practice Address - Phone:757-450-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANA261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty