Provider Demographics
NPI:1366233991
Name:GREEN, JESICA (RN, MFT INTERN)
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN, MFT INTERN
Other - Prefix:
Other - First Name:JESICA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2819 NILES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:VONORE
Mailing Address - State:TN
Mailing Address - Zip Code:37885-2640
Mailing Address - Country:US
Mailing Address - Phone:423-557-8610
Mailing Address - Fax:
Practice Address - Street 1:705 GATE LN STE 202
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3521
Practice Address - Country:US
Practice Address - Phone:865-268-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist