Provider Demographics
NPI:1952661696
Name:GREEN-BURNS, JESSICA RENEE (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RENEE
Last Name:GREEN-BURNS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RENEE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:638 MUSTANG CANYON DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8318
Mailing Address - Country:US
Mailing Address - Phone:614-634-8801
Mailing Address - Fax:
Practice Address - Street 1:8687 E VIA DE VENTURA STE 310
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3351
Practice Address - Country:US
Practice Address - Phone:480-866-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025525363LP0808X
RIAPRN02986363LP0808X
MECNP211365363LP0808X
AZ235439363LP0808X
OH3574753245S0500X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children