Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN197929 | GA |
NPI | 1053662874 |
---|---|
Provider Name | Jessi Lucas Hale |
First Address | Columbus, GA 31904-3353 |
Second Address | Columbus, GA 31904-3353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2012 |
Last Update Date | 03/12/2015 |