Provider Demographics
NPI:1548686074
Name:NYMEYER, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:NYMEYER
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 1:808 COLUMBUS AVE
Mailing Address - Street 2:APT 15N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5139
Mailing Address - Country:US
Mailing Address - Phone:206-313-8656
Mailing Address - Fax:
Practice Address - Street 1:808 COLUMBUS AVE
Practice Address - Street 2:APT 15N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5139
Practice Address - Country:US
Practice Address - Phone:206-313-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627787-1163W00000X
NY430891363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse