MEDICARE: JESSICA KC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN-NP319377	GA

General Provider Information

NPI Number	:	1679431761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KC

Provider Business Mailing Address
First Line	:	2533 BRADFORD SQ NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-1335
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2533 BRADFORD SQ NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-1335
Country	:	US
Telephone Number	:	678-222-6157
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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Directions to “ JESSICA KC ” Practice Location

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