MEDICARE: JESSICA LEE HUCKINS RNFA

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
1	163WR0006X	Registered Nurse First Assistant	23136	WY

General Provider Information

NPI Number	:	1215478136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEE HUCKINS RNFA

Provider Business Mailing Address
First Line	:	203 HUNTINGTON DR
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-5770
Country	:	US
Telephone Number	:	307-299-7006
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 HUNTINGTON DR
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-5770
Country	:	US
Telephone Number	:	307-299-7006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	05/10/2019

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