Provider Demographics
NPI:1699426551
Name:SWAN, JESSIE ALLEN
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:ALLEN
Last Name:SWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 STONES TRAILER CT TRLR A4
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1820
Mailing Address - Country:US
Mailing Address - Phone:304-654-0378
Mailing Address - Fax:
Practice Address - Street 1:7700 STONES TRAILER CT TRLR A4
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1820
Practice Address - Country:US
Practice Address - Phone:304-654-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant