Provider Demographics
NPI:1982413019
Name:MCDANIEL, JESSICA BROOKE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BROOKE
Last Name:MCDANIEL
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 1:616 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1638
Mailing Address - Country:US
Mailing Address - Phone:681-212-1703
Mailing Address - Fax:
Practice Address - Street 1:616 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1638
Practice Address - Country:US
Practice Address - Phone:681-212-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant