MEDICARE: JESSICA DENISE WATTS

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1386112795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DENISE WATTS

Provider Business Mailing Address
First Line	:	100 COVINGTON PARK DR APT 621
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-5055
Country	:	US
Telephone Number	:	601-937-6683
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 E RIVER PL STE 504
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-3487
Country	:	US
Telephone Number	:	769-251-5427
Fax Number	:	769-251-5428

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

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	05/13/2025

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Directions to “ JESSICA DENISE WATTS ” Practice Location

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