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NPI Code Detail

MEDICARE: KIMBERLY JESSUP

MEDICARE: KIMBERLY JESSUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor11252NY

General Provider Information

NPI Number : 1346330107
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY JESSUP
Provider Business Mailing Address
First Line : 4445 TUCKER RD # A
Second Line :
City : CAMPBELL
State : NY
Zip : 14821-9744
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 115 LIBERTY ST
Second Line :
City : BATH
State : NY
Zip : 14810-1508
Country : US
Telephone Number : 607-776-6577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 07/08/2007

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Directions to “ KIMBERLY JESSUP ” Practice Location

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