Provider Demographics
NPI:1992067649
Name:MARSHALL, JESSICA LYNN (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 LAFFERTY LN APT 6
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8848
Mailing Address - Country:US
Mailing Address - Phone:386-316-8802
Mailing Address - Fax:
Practice Address - Street 1:400 UNIVERSITY DR STE 212B
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1080
Practice Address - Country:US
Practice Address - Phone:606-886-8183
Practice Address - Fax:606-886-0575
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3141208600000X
390200000X
KY04413208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty