Provider Demographics
NPI:1588273494
Name:COKER, JESSICA LASHAE (DNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LASHAE
Last Name:COKER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GOLFE LINKS DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4731
Mailing Address - Country:US
Mailing Address - Phone:662-633-9410
Mailing Address - Fax:
Practice Address - Street 1:3500 GOLFE LINKS DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4731
Practice Address - Country:US
Practice Address - Phone:662-633-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258063363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health