Provider Demographics
NPI:1134733199
Name:BOBY, JESTY (FNP-C)
Entity type:Individual
Prefix:
First Name:JESTY
Middle Name:
Last Name:BOBY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 AUTUMN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7934
Mailing Address - Country:US
Mailing Address - Phone:678-982-6728
Mailing Address - Fax:
Practice Address - Street 1:751 AUTUMN MEADOW DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7934
Practice Address - Country:US
Practice Address - Phone:678-982-6728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA192978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily