Basic Information
| Provider Information | |||||||||
| NPI: | 1093723785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JESSER | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1718 PATTERSON ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153271085 | ||||||||
| FaxNumber: | 6159634733 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 CHURCH ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159634732 | ||||||||
| FaxNumber: | 6152501319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4422 | TN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 3730393 | 05 | TN | MEDICAID |