Provider Demographics
NPI:1124649926
Name:MILLER, JESSICA JOHNSON (FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOHNSON
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DELORES
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 MATTHEWS CIR
Mailing Address - Street 2:
Mailing Address - City:NAHUNTA
Mailing Address - State:GA
Mailing Address - Zip Code:31553-4424
Mailing Address - Country:US
Mailing Address - Phone:912-282-6068
Mailing Address - Fax:
Practice Address - Street 1:3025 SHRINE RD STE 270
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4785
Practice Address - Country:US
Practice Address - Phone:912-262-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily