Provider Demographics
NPI:1710002225
Name:JESTEL, JENNIFER L (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:JESTEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:39 OAK HILL CT BLDG C
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2392
Mailing Address - Country:US
Mailing Address - Phone:770-683-7873
Mailing Address - Fax:770-683-7870
Practice Address - Street 1:39 OAK HILL CT
Practice Address - Street 2:BUILDING C
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2392
Practice Address - Country:US
Practice Address - Phone:770-683-7873
Practice Address - Fax:770-683-7870
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169469363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner