Provider Demographics
NPI:1699578302
Name:COLE, JESSIE ELLEN
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:ELLEN
Last Name:COLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 US ROUTE 60 E
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1609
Mailing Address - Country:US
Mailing Address - Phone:304-733-0036
Mailing Address - Fax:
Practice Address - Street 1:16 HARMONY LN
Practice Address - Street 2:
Practice Address - City:LAVALETTE
Practice Address - State:WV
Practice Address - Zip Code:25535-8006
Practice Address - Country:US
Practice Address - Phone:304-646-0806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator