Individual provider Active NPI

Jessica Faye Bohannon, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Greenville, TX
National Provider Identifier
1780491001
Registry record updated Apr 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1179922 Issued in TX
Practice address
301 Division St
Greenville, TX 75401-4101
Phone
(903) 453-3385
NPI assigned
Dec 11, 2024
Last updated
Apr 9, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1179922 TX Primary

Addresses

Primary practice location

301 Division St
Greenville, TX 75401-4101

Mailing address

4161 County Road 2727
Caddo Mills, TX 75135-5624
Phone (903) 461-4100

Other practice location 1

2200 Traders Rd Ste 501
Greenville, TX 75402-8314
Phone (903) 231-3151

Other practice location 2

3012 Ridge Rd Ste 100
Rockwall, TX 75032-1918
Phone (972) 246-8999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20250425001556 TX Practitioner - Nurse Practitioner 4981130804 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Raza H. Sayed MD, PAGroup PAC ID 8123179066, 4 clinicians

Practice addresses (Care Compare)

2710 Sunset Strip
Suite D
Greenville, TX 75402-3849
Phone (903) 321-3151

National Provider Directory

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

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1733875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775692800000",
    "number": "1780491001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4161 COUNTY ROAD 2727",
            "city": "CADDO MILLS",
            "state": "TX",
            "postal_code": "751355624",
            "telephone_number": "903-461-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 DIVISION ST",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754014101",
            "telephone_number": "903-453-3385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Traders Rd Ste 501",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "TX",
            "postal_code": "754028314",
            "country_code": "US",
            "telephone_number": "903-231-3151",
            "fax_number": "903-418-3785",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3012 Ridge Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Rockwall",
            "state": "TX",
            "postal_code": "750321918",
            "country_code": "US",
            "telephone_number": "972-246-8999",
            "fax_number": "903-418-3785",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOHANNON",
        "first_name": "JESSICA",
        "middle_name": "FAYE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-11",
        "last_updated": "2026-04-09",
        "certification_date": "2026-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1179922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, TX

Sources for this page

Verify at the official NPI Registry.