Jessica Lee Cornelius

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Practice address

629 21St St S Apt 4
Fargo, ND 58103-2487

Phone

(701) 353-9257

NPI assigned

Oct 13, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jessica Lee Puckett Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1003578402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 6TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032411",
            "telephone_number": "701-515-8117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 21ST ST S APT 4",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032487",
            "telephone_number": "701-353-9257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELIUS",
        "first_name": "JESSICA",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-13",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "PUCKETT",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Personal Care Attendant in Fargo, ND
• Providers in Fargo, ND by specialty
• Personal Care Attendant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.