Healthcare Provider Details

I. General information

NPI: 1114539020
Provider Name (Legal Business Name): JESSICA BURRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 MCGUFFIN LN
GALLIPOLIS FERRY WV
25515-7175
US

IV. Provider business mailing address

278 MCGUFFIN LN
GALLIPOLIS FERRY WV
25515-7175
US

V. Phone/Fax

Practice location:
  • Phone: 304-674-3150
  • Fax:
Mailing address:
  • Phone: 304-674-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: