Jessica Christina Haynes, PRSS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

21-9104 Issued in WV

Practice address

908 Washington St
Ravenswood, WV 26164-1143

Phone

(304) 531-9678

NPI assigned

Oct 5, 2022

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 Christina Angus Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1664928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1760107544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 WILSON ST",
            "city": "RAVENSWOOD",
            "state": "WV",
            "postal_code": "261641533",
            "telephone_number": "304-531-9678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 WASHINGTON ST",
            "city": "RAVENSWOOD",
            "state": "WV",
            "postal_code": "261641143",
            "telephone_number": "304-531-9678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "JESSICA",
        "middle_name": "CHRISTINA",
        "credential": "PRSS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-05",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "WV",
            "license": "21-9104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "ANGUS",
            "middle_name": "CHRISTINA",
            "credential": "PRSS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Peer Specialist in Ravenswood, WV
• Providers in Ravenswood, WV by specialty
• Peer Specialist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.