Jessica Diane Membrillo, AGACNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN259993 Issued in GA

Practice address

145 Riverstone Ter Ste 101
Canton, GA 30114-5327

Phone

(770) 450-4807

NPI assigned

Jan 17, 2022

Last updated

Oct 9, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jessica Diane Smith Former name

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/27392/brand/1/csg/1/fhir/r4
• Direct secure messaging: jessica.membrillo.1@27392.direct.athenahealth.com

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

• Nova Spine and Pain Care PC

  dba Nova Spine and Pain Care

  • Pain Medicine (Anesthesiology) Physician
  • Canton, GA
  • NPI 1225759236
  Medicare reassignment NPD

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

{
    "created_epoch": "1642377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1235880634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 FOREST PINE DR",
            "city": "BALL GROUND",
            "state": "GA",
            "postal_code": "301075196",
            "telephone_number": "770-608-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 RIVERSTONE TER STE 101",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301145327",
            "telephone_number": "770-450-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMBRILLO",
        "first_name": "JESSICA",
        "middle_name": "DIANE",
        "credential": "AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-17",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN259993",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN259993",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "SMITH",
            "middle_name": "DIANE",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John C Meiners Jr., DC
• Tenisha L. Meko, NP-C
• Matthew Meleka, D.O.
• Stephanie L Mello, MA CCC SLP
• Brooke Melton, PHARMD
• Mayra Mendez-Schiaffino
• Ada Ivette Mercado, MD
• Meridian Health and Wellness LLC
• Scott Vidar Merritt, DMD
• David C. Meyer, M.D.

• Nurse Practitioner in Canton, GA
• Providers in Canton, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.