Provider Demographics
NPI:1902496656
Name:RIVERS, JESSI LYN (RN, BSN)
Entity Type:Individual
Prefix:MISS
First Name:JESSI
Middle Name:LYN
Last Name:RIVERS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:LYN
Other - Last Name:FROEBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:1619 E PEACHAM RD
Mailing Address - Street 2:
Mailing Address - City:PEACHAM
Mailing Address - State:VT
Mailing Address - Zip Code:05862-7900
Mailing Address - Country:US
Mailing Address - Phone:802-752-5392
Mailing Address - Fax:
Practice Address - Street 1:1715 N WEST SHORE BLVD STE 410
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3902
Practice Address - Country:US
Practice Address - Phone:855-623-3587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN-TEMP3816163W00000X
NH082322-21163W00000X
CT176787163W00000X
NY808927163W00000X
VT026.0095693163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse