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General NPI Number Information
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NPI Number | 1285856245
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Entity Type | Individual
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Provider Name | JESSICA LYNN PUCKETT DO
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 711 S HEALTH PKWY STE 1
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City | THREE RIVERS
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State | MI
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Zip | 49093-8354
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Country | US
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Telephone | 269-273-8557
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Fax | 269-279-6461
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DR STE 100
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City | GRANGER
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State | IN
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Zip | 46530-1380
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5101015674
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License Number State | MI
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