Provider Demographics
NPI:1538730932
Name:CRAIN, JESSI RAE
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:RAE
Last Name:CRAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 RUNNING W DR APT 208
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-2066
Mailing Address - Country:US
Mailing Address - Phone:307-714-4001
Mailing Address - Fax:
Practice Address - Street 1:542 RUNNING W DR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-2074
Practice Address - Country:US
Practice Address - Phone:307-257-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty