Individual
MISS JESSICA NICOLE MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP, PMHNP
Contact information
Practice address
14100 CEDAR RD STE 390-2, CLEVELAND, OH 44121-3212
(216) 905-0099
Mailing address
2616 EDGEWOOD RD, BEACHWOOD, OH 44122-1560
(216) 647-7449
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
312983
OH
363LF0000X
Family Nurse Practitioner
14506
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
14506
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0085765
—
OH
01
—
2573433
PROVIDER NUMBER
OH
Enumeration date
07/02/2007
Last updated
03/02/2022
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