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Individual
REVONDA LASHAWN JESSUP
Active
Individual
REVONDA LASHAWN JESSUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
505
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081CP
BCBS
NC
01
—
1551892
AETNA
NC
01
—
197970
MEDCOST
NC
05
—
5907484
—
NC
01
—
6024065
CIGNA
NC
05
—
NPD505
—
SC
Enumeration date
05/17/2007
Last updated
01/24/2023
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