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NPI Code Detail

MEDICARE: JESICA GREEN RN, MFT INTERN

MEDICARE: JESICA GREEN RN, MFT INTERN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1366233991
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESICA GREEN RN, MFT INTERN
Provider Business Mailing Address
First Line : 2819 NILES FERRY RD
Second Line :
City : VONORE
State : TN
Zip : 37885-2640
Country : US
Telephone Number : 423-557-8610
Fax Number :
Provider Business Practice Location Address
First Line : 705 GATE LN STE 202
Second Line :
City : KNOXVILLE
State : TN
Zip : 37909-3521
Country : US
Telephone Number : 865-268-9653
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2025
Last Update Date : 05/14/2025

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Directions to “ JESICA GREEN RN, MFT INTERN” Practice Location

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