Healthcare Provider Details

I. General information

NPI: 1669152799
Provider Name (Legal Business Name): JESSICA WINDON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3934 WOODRUFF RD
COLUMBUS GA
31904-6818
US

IV. Provider business mailing address

106 ENTERPRISE CT STE C
COLUMBUS GA
31904-9096
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-0304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN268969
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: