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1700647872 NPI number — JESSICA ANNE GOEDJEN APRN

NPI Number: 1700647872
Health Care Provider/Practitioner: JESSICA ANNE GOEDJEN APRN

Information about “1700647872” NPI (JESSICA ANNE GOEDJEN APRN) exists in 1700647872 in HTML format HTML  |  1700647872 in plain Text format TXT  |  1700647872 in PDF (Portable Document Format) PDF  |  1700647872 in an XML format XML  formats.

NPI Number : 1700647872 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700647872",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOEDJEN",
    "FirstName": "JESSICA",
    "MiddleName": "ANNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KRAUS",
    "OtherFirstName": "JESSICA",
    "OtherMiddleName": "ANNE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "APRN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1396 CANOOCHEE DR NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BROOKHAVEN",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30319-3432",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "313-598-2272",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "401 S MAIN ST STE A4",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALPHARETTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30009-1957",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-598-2272",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/17/2024",
    "LastUpdateDate": "10/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "APRN-NP247558",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "RN247558",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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