Provider Demographics
NPI:1053662874
Name:HALE, JESSI LUCAS (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSI
Middle Name:LUCAS
Last Name:HALE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 RIVER RD STE 301
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3353
Mailing Address - Country:US
Mailing Address - Phone:706-494-0694
Mailing Address - Fax:706-494-0695
Practice Address - Street 1:6801 RIVER RD STE 301
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3353
Practice Address - Country:US
Practice Address - Phone:706-494-0694
Practice Address - Fax:706-494-0695
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197929363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care