Healthcare Provider Details

I. General information

NPI: 1104731223
Provider Name (Legal Business Name): JESSICA R. PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA R. WILES MARRIED NAME

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 N MARKET ST
LISBON OH
44432-1017
US

IV. Provider business mailing address

659 N MARKET ST
LISBON OH
44432-1017
US

V. Phone/Fax

Practice location:
  • Phone: 724-510-5276
  • Fax:
Mailing address:
  • Phone: 724-510-5276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: