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NPI Code Detail

MEDICARE: JESSICA DARLENE FANNIN LPN

MEDICARE: JESSICA DARLENE FANNIN LPN
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
1164W00000XLicensed Practical Nurse2052118KY

General Provider Information

NPI Number : 1750598074
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA DARLENE FANNIN LPN
Provider Business Mailing Address
First Line : 1228 MILLDALE RD
Second Line :
City : PORTSMOUTH
State : OH
Zip : 45662-8700
Country : US
Telephone Number : 740-876-8290
Fax Number : 740-529-1205
Provider Business Practice Location Address
First Line : 729 6TH ST
Second Line :
City : PORTSMOUTH
State : OH
Zip : 45662-4030
Country : US
Telephone Number : 740-876-8290
Fax Number : 740-529-1205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 12/16/2025

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Directions to “ JESSICA DARLENE FANNIN LPN” Practice Location

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