Provider Demographics
NPI:1689402422
Name:TRAN, JESSICA R (PCA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:R
Last Name:TRAN
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:RENEE
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PCA
Mailing Address - Street 1:104 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-6066
Mailing Address - Country:US
Mailing Address - Phone:336-947-0755
Mailing Address - Fax:
Practice Address - Street 1:104 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6066
Practice Address - Country:US
Practice Address - Phone:336-947-0755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide