Basic Information
Provider Information
NPI: 1366734022
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NASH
FirstName: JENNIFER
MiddleName: S.
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1225 E WEISGARBER RD
Address2: SUITE 200
City: KNOXVILLE
State: TN
PostalCode: 379092604
CountryCode: US
TelephoneNumber: 8655844747
FaxNumber: 8655841363
Practice Location
Address1: 6537 KINGSTON PIKE
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379194826
CountryCode: US
TelephoneNumber: 8655589822
FaxNumber: 8655885305
Other Information
ProviderEnumerationDate: 05/12/2011
LastUpdateDate: 11/16/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA0000001970TNY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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