Healthcare Provider Details

I. General information

NPI: 1104439298
Provider Name (Legal Business Name): JESSICA DAWN GRIFFIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 SOUTH COURT STREET
HARRISVILLE WV
26362
US

IV. Provider business mailing address

1526 DOE RUN
WEST UNION WV
26456-6009
US

V. Phone/Fax

Practice location:
  • Phone: 304-643-4941
  • Fax: 304-643-4936
Mailing address:
  • Phone: 304-483-3507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number79874
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: