Provider Demographics
NPI:1659630945
Name:ROBERTS, JESSICA CROWE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CROWE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 FORSYTH ST
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8637
Mailing Address - Country:US
Mailing Address - Phone:478-743-7068
Mailing Address - Fax:478-741-1354
Practice Address - Street 1:1062 FORSYTH ST
Practice Address - Street 2:SUITE 1-B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8637
Practice Address - Country:US
Practice Address - Phone:478-743-7068
Practice Address - Fax:478-741-1354
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHEL31078363LF0000X
GARN180140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily