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JESSICA DIANE MEMBRILLO AGACNP-BC
NPI 1235880634
Nurse Practitioner in Canton, GA

Active since January 17, 2022PECOS Enrolled
145 RIVERSTONE TER STE 101, CANTON, GA 30114(770) 450-4807 Get Directions Write a Review

NPPES record last updated: October 9, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 9, 2025, Oct 30, 2023, Jun 23, 2023 and 1 more (4 updates tracked since 2022).

About Jessica Diane Membrillo Agacnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA DIANE MEMBRILLO AGACNP-BC (NPI 1235880634) is an individual nurse practitioner in Canton, Georgia, licensed in Georgia (RN259993) and active in the NPI registry since January 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1235880634
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameJESSICA DIANE MEMBRILLOCredential: AGACNP-BC
Location Address145 RIVERSTONE TER STE 101Canton, GA 30114-5327
Mailing Address606 Forest Pine DrBall Ground, GA 30107-5196 · (770) 608-4407
Phone(770) 450-4807
Sole ProprietorYes
Enumeration DateJanuary 17, 2022
Last NPPES UpdateOctober 9, 20254 updates tracked since enumeration
NPPES CertifiedOctober 9, 2025
✔ NPI 1235880634 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in GA · RN259993
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedRegistered NurseTaxonomy 163W00000X · License RN259993 (GA)
145 RIVERSTONE TER STE 101, Canton, GA 30114
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Other Names 1

Former Name (1)Jessica Diane Smith Rn

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jessica Diane Membrillo Agacnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30114 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NOVA SPINE AND PAIN CARE PC
Anesthesiology (Pain Medicine)
145 RIVERSTONE TER STE 101
CANTON, GA 30114
Cherokee County (770) 450-4807
WESLEY WARREN LUDWIG M.D.
Urology
145 RIVERSTONE TER STE 101
CANTON, GA 30114
Cherokee County (770) 720-7246
CHITRA RAMASUBBU MD
Anesthesiology (Pain Medicine)
145 RIVERSTONE TER STE 101
CANTON, GA 30114
Cherokee County (770) 450-4807

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessica Membrillo's NPI number?

The NPI number for Jessica Membrillo is 1235880634. It was assigned to this individual provider in the NPPES registry on January 17, 2022. The provider is also known as Jessica Diane Smith Rn.

Where is Jessica Membrillo located?

Jessica Membrillo practices at 145 Riverstone Ter Ste 101, Canton, GA 30114. The listed phone number is (770) 450-4807.

What is Jessica Membrillo's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Jessica Membrillo enrolled in Medicare?

Yes. Jessica Membrillo is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jessica Membrillo was last updated on October 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.