Provider Demographics
NPI:1538632369
Name:CRAFT, JESSICA HENDERSON (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HENDERSON
Last Name:CRAFT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 STILLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-4798
Mailing Address - Country:US
Mailing Address - Phone:704-902-3702
Mailing Address - Fax:
Practice Address - Street 1:1330 MERCER ST STE 1
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3066
Practice Address - Country:US
Practice Address - Phone:304-431-2000
Practice Address - Fax:304-431-2002
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190173363L00000X
WV111511363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner