Provider Demographics
NPI:1861384323
Name:PORTER, JESSICA JOANNA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOANNA
Last Name:PORTER
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 1:615 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1252
Mailing Address - Country:US
Mailing Address - Phone:419-605-5313
Mailing Address - Fax:
Practice Address - Street 1:131 KEPLAR ST
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2026
Practice Address - Country:US
Practice Address - Phone:419-605-1913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide