Provider Demographics
NPI:1891768339
Name:CRAIG, JESSICA LEA (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEA
Last Name:CRAIG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300-B EAST THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2700
Mailing Address - Country:US
Mailing Address - Phone:423-702-7900
Mailing Address - Fax:423-702-7905
Practice Address - Street 1:251 LYERLY STREET
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2136
Practice Address - Country:US
Practice Address - Phone:423-826-8000
Practice Address - Fax:423-826-8005
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144337 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA194286372AMedicaid
GAQ24827Medicare UPIN
GA194286372AMedicaid
TN103I507745Medicare PIN