Basic Information
| Provider Information | |||||||||
| NPI: | 1164476099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEHRIO-BUTLER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1370 GATEWAY BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158909008 | ||||||||
| FaxNumber: | 6158900193 | ||||||||
| Practice Location | |||||||||
| Address1: | 1370 GATEWAY BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158909008 | ||||||||
| FaxNumber: | 6158900193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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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 | 208000000X | 2008-01044 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1515244 | 05 | TN | MEDICAID |