Basic Information
| Provider Information | |||||||||
| NPI: | 1063904324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORICK | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 156 PARKVIEW DR | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378413383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232151559 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1855 TANNER WAY STE 110 | ||||||||
| Address2: | |||||||||
| City: | HARRIMAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654812541 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2018 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 24009 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 24009 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.