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General NPI Number Information
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NPI Number | 1972914497
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Entity Type | Individual
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Provider Name | JESSICA LYNNE COURSON NP-C
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Gender | Female
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 903 WEST WARD STREET SUITE B
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City | DOUGLAS
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State | GA
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Zip | 31533
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Country | US
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Telephone | 912-260-1191
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Fax | 912-260-1193
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Provider Business Mailing Address
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Address Line | 1111 GLYNCO PARKWAY BLDG1 STE 10
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City | BRUNSWICK
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State | GA
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Zip | 31525
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Country | US
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Telephone | 912-264-9111
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Fax | 912-262-6909
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN190877
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License Number State | GA
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