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General NPI Number Information
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NPI Number | 1366355836
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Entity Type | Individual
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Provider Name | JERISSA JOY WARD
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Gender | Female
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 525 N STATE OF FRANKLIN RD
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City | JOHNSON CITY
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State | TN
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Zip | 37604-8213
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Country | US
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Telephone | 423-220-8850
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 LEDFORD ST
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City | ELIZABETHTON
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State | TN
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Zip | 37643-3423
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Country | US
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Telephone | 423-943-4541
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-26-2854288
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License Number State | TN
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