Jessica Elizabeth Russom

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

2995 Warrior LN
Poplar Bluff, MO 63901-8600

Phone

(573) 712-2902

NPI assigned

Sep 13, 2024

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Counseling Center, Inc.

  • Primary Care Clinic/Center
  • Poplar Bluff, MO
  • NPI 1235738493
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 13, 2024.

{
    "created_epoch": "1726185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1225864366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 WARRIOR LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639018600",
            "telephone_number": "573-712-2902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2995 WARRIOR LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639018600",
            "telephone_number": "573-712-2902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSOM",
        "first_name": "JESSICA",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-13",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack Douglas Rushin, D.C.
• Alexandra Denise Russell, DPT
• Debra G Russell, FNP
• Shilo Russell
• Victoria Russell
• Wyatt Russom
• Mercy Rathini Sabapathypillai, M.D.
• Mahmoud Sagharichi, PHD
• Shazib Sagheer, MD
• Saint Francis Medical Center

• All providers in Poplar Bluff, MO
• Behavior Technician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; 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.