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General NPI Number Information
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NPI Number | 1588536353
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Entity Type | Individual
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Provider Name | MRS. JESSICA LYN LEDBETTER
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Gender | Female
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 101 RIVERSTONE VIS STE 102
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City | BLUE RIDGE
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State | GA
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Zip | 30513-6630
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Country | US
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Telephone | 706-258-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 1835 SAVOY DR STE 203
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City | ATLANTA
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State | GA
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Zip | 30341-1073
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Country | US
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Telephone | 770-496-9430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN159898
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-NP159898
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License Number State | GA
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