MEDICARE: JESSICA WYNNS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	172A00000X	Driver
2	347C00000X	Private Vehicle
3	376J00000X	Homemaker	OH

General Provider Information

NPI Number	:	1891624136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WYNNS

Provider Business Mailing Address
First Line	:	6158 SPRING ST
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-1369
Country	:	US
Telephone Number	:	330-968-5341
Fax Number	:

Provider Business Practice Location Address
First Line	:	6158 SPRING ST
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-1369
Country	:	US
Telephone Number	:	330-968-5341
Fax Number	:

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

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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Directions to “ JESSICA WYNNS ” Practice Location

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