Provider Demographics
NPI:1699046524
Name:MCGINTY, JESSICA (CHA-IV)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MCGINTY
Suffix:
Gender:F
Credentials:CHA-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:KALTAG
Mailing Address - State:AK
Mailing Address - Zip Code:99748
Mailing Address - Country:US
Mailing Address - Phone:907-534-2209
Mailing Address - Fax:
Practice Address - Street 1:32 SECOND ST
Practice Address - Street 2:
Practice Address - City:KALTAG
Practice Address - State:AK
Practice Address - Zip Code:99748
Practice Address - Country:US
Practice Address - Phone:907-534-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10-1088-IV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker