MEDICARE: JESSICA SIEGLING

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	164W00000X	Licensed Practical Nurse	38835	WV

General Provider Information

NPI Number	:	1457078479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SIEGLING

Provider Business Mailing Address
First Line	:	RR 1 BOX 403
Second Line	:
City	:	SALT ROCK
State	:	WV
Zip	:	25559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7838 WV-10
Second Line	:
City	:	SALT ROCK
State	:	WV
Zip	:	25559-2555
Country	:	US
Telephone Number	:	304-942-5303
Fax Number	:	304-691-1037

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

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	11/07/2022

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Directions to “ JESSICA SIEGLING ” Practice Location

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