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NPI Code Detail

MEDICARE: JESSICA DAWN LARGE FNP-C

MEDICARE: JESSICA DAWN LARGE FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician124999WV

General Provider Information

NPI Number : 1013861954
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA DAWN LARGE FNP-C
Provider Business Mailing Address
First Line : 167 MUZZLELOADER LN APT 202
Second Line :
City : MARTINSBURG
State : WV
Zip : 25404-1145
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4055 VALLEY VIEW LN STE 700
Second Line :
City : DALLAS
State : TX
Zip : 75244-5045
Country : US
Telephone Number : 855-984-5121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2026
Last Update Date : 02/26/2026

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