Provider Demographics
NPI:1790490118
Name:ROSS, JESSICA NICOLE (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NICOLE
Last Name:ROSS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:TOONE
Mailing Address - State:TN
Mailing Address - Zip Code:38381-7806
Mailing Address - Country:US
Mailing Address - Phone:731-609-5389
Mailing Address - Fax:
Practice Address - Street 1:16530 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-6185
Practice Address - Country:US
Practice Address - Phone:901-813-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily