Provider Demographics
NPI:1902657968
Name:FAUST, JESSICA (PMHNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FAUST
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WHIRLAWAY CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9145
Mailing Address - Country:US
Mailing Address - Phone:270-723-1590
Mailing Address - Fax:
Practice Address - Street 1:27 WHIRLAWAY CT
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9145
Practice Address - Country:US
Practice Address - Phone:270-723-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-05-03
Deactivation Date:2024-04-13
Deactivation Code:
Reactivation Date:2024-05-03
Provider Licenses
StateLicense IDTaxonomies
KY11520042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry