Healthcare Provider Details

I. General information

NPI: 1659630945
Provider Name (Legal Business Name): JESSICA CROWE ROBERTS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 FORSYTH ST SUITE 1-B
MACON GA
31201-8637
US

IV. Provider business mailing address

1062 FORSYTH ST SUITE 1-B
MACON GA
31201-8637
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-7068
  • Fax: 478-741-1354
Mailing address:
  • Phone: 478-743-7068
  • Fax: 478-741-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberEL31078
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN180140
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37063
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: