Provider Demographics
NPI:1679748842
Name:FOUT, JESSICA DAWN (LPN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:FOUT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 COUNTY ROAD 19
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645-8524
Mailing Address - Country:US
Mailing Address - Phone:740-534-9488
Mailing Address - Fax:
Practice Address - Street 1:2177 COUNTY ROAD 19
Practice Address - Street 2:
Practice Address - City:KITTS HILL
Practice Address - State:OH
Practice Address - Zip Code:45645-8524
Practice Address - Country:US
Practice Address - Phone:740-534-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN109695164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse