Provider Demographics
NPI:1437668407
Name:JACKSON LOVE, JESSICA LYNN (DOULA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:JACKSON LOVE
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DOULA
Mailing Address - Street 1:3046 MELKRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-7371
Mailing Address - Country:US
Mailing Address - Phone:740-497-8803
Mailing Address - Fax:
Practice Address - Street 1:3046 MELKRIDGE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-7371
Practice Address - Country:US
Practice Address - Phone:740-497-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNONE