Provider Demographics
NPI:1447979539
Name:MCGILVRAY, JESSICA LEE (CPM, LLM, CLC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:MCGILVRAY
Suffix:
Gender:F
Credentials:CPM, LLM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W RACE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4237
Mailing Address - Country:US
Mailing Address - Phone:501-316-8811
Mailing Address - Fax:
Practice Address - Street 1:120 W RACE AVE STE 7
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4237
Practice Address - Country:US
Practice Address - Phone:501-316-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula