Provider Demographics
NPI:1871334938
Name:GREEN, JESSICA LEE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEE
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 FERRELL AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2371
Mailing Address - Country:US
Mailing Address - Phone:423-239-0099
Mailing Address - Fax:423-239-0273
Practice Address - Street 1:106 FERRELL AVE STE 5
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2371
Practice Address - Country:US
Practice Address - Phone:423-239-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily