Individual provider Active NPI

Jessica Brooke Wren, NP

  • Family Nurse Practitioner
  • Richmond Hill, GA
National Provider Identifier
1124563713
Registry record updated Jan 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN190747NP Issued in GA
Practice address
89 Interchange Dr
Richmond Hill, GA 31324-7661
Phone
(912) 527-5301
Fax
(912) 756-4740
NPI assigned
Jan 5, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN190747NP GA Primary

Addresses

Primary practice location

89 Interchange Dr
Richmond Hill, GA 31324-7661

Mailing address

PO Box 15849
Savannah, GA 31416-2549
Phone (912) 303-3560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170208000042 GA Practitioner - Nurse Practitioner 9335422849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Effingham Rehab Services, LLCGroup PAC ID 5597752063, shared by 3 NPIs, 143 clinicians

Practice addresses (Care Compare)

1390 Boone Ave Ext
Suite A23
Kingsland, GA 31548-6515
Phone (419) 221-3717

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group of Georgia LLC CurrentSince May 1, 2019 Accepting new patients
Privia Medical Group of Georgia LLC CurrentSince May 1, 2019 Accepting new patients
Coastal Ear Nose & Throat, LLC PastSince Oct 1, 2022 Accepting new patients

Locations

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

89 Interchange Dr
Richmond Hill, GA 31324
Phone (912) 527-5301

1326 Eisenhower Dr
#1
Savannah, GA 31406
Phone (912) 691-4100

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483574400000",
    "number": "1124563713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15849",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314162549",
            "telephone_number": "912-303-3560",
            "fax_number": "912-303-3506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 INTERCHANGE DR",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313247661",
            "telephone_number": "912-527-5301",
            "fax_number": "912-756-4740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WREN",
        "first_name": "JESSICA",
        "middle_name": "BROOKE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-05",
        "last_updated": "2017-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN190747NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond Hill, GA

Sources for this page

Verify at the official NPI Registry.