Healthcare Provider Details

I. General information

NPI: 1639936438
Provider Name (Legal Business Name): JESSICA LINDSAY DRIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 US HIGHWAY 280 W
AMERICUS GA
31719-8645
US

IV. Provider business mailing address

126 US HIGHWAY 280 W
AMERICUS GA
31719-8645
US

V. Phone/Fax

Practice location:
  • Phone: 299-924-6011
  • Fax:
Mailing address:
  • Phone: 229-924-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN257732
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN257732
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: