# JESSICA RUSSELL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1710521778
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WN0800X | Neuroscience Registered Nurse | RN239269 | GA | — |
| 363L00000X | Nurse Practitioner | RN239269 | GA | Yes |

## Other

- **Enumeration date:** 11/03/2019
- **Last updated:** 09/21/2022