Healthcare Provider Details

I. General information

NPI: 1922921311
Provider Name (Legal Business Name): CAROLINE JESSEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26208 LEE HWY
ABINGDON VA
24211-7504
US

IV. Provider business mailing address

1360 RIVERBEND DR APT 105
KINGSPORT TN
37664-4079
US

V. Phone/Fax

Practice location:
  • Phone: 276-258-5537
  • Fax:
Mailing address:
  • Phone: 276-206-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011527
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: