Healthcare Provider Details

I. General information

NPI: 1770719452
Provider Name (Legal Business Name): JESSICA NICOLE LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA NICOLE THORNTON CNP

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

IV. Provider business mailing address

1014 FISH AND GAME RD
WAVERLY OH
45690-9675
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-7500
  • Fax:
Mailing address:
  • Phone: 740-701-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA16670
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN324394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: