Provider Demographics
NPI:1770113920
Name:GARCIA, JESSICA MASSEY (NP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MASSEY
Last Name:GARCIA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MASSEY
Other - Last Name:MEDLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1220 BILL WALLACE DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37737-2558
Mailing Address - Country:US
Mailing Address - Phone:865-712-6479
Mailing Address - Fax:
Practice Address - Street 1:1123 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5130
Practice Address - Country:US
Practice Address - Phone:865-724-0867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily