Provider Demographics
NPI:1689025447
Name:GREGG, JESSICA (APRN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:GREGG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:JUNIATA
Mailing Address - State:NE
Mailing Address - Zip Code:68955
Mailing Address - Country:US
Mailing Address - Phone:402-984-6564
Mailing Address - Fax:
Practice Address - Street 1:715 N KANSAS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4453
Practice Address - Country:US
Practice Address - Phone:402-460-5787
Practice Address - Fax:402-460-5794
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112037363LA2100X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care