Basic Information
| Provider Information | |||||||||
| NPI: | 1235577537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | HOWELL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7730 DANNAHER DR | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378494039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655247107 | ||||||||
| FaxNumber: | 8655243709 | ||||||||
| Practice Location | |||||||||
| Address1: | 7730 DANNAHER DR | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378494039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655247107 | ||||||||
| FaxNumber: | 8655243709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2013 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 2332 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.