Basic Information
| Provider Information | |||||||||
| NPI: | 1447282611 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEEKS | ||||||||
| FirstName: | JIMMY | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 754 N MOUNT JULIET RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT JULIET | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371223323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157542828 | ||||||||
| FaxNumber: | 6517542818 | ||||||||
| Practice Location | |||||||||
| Address1: | 754 N MOUNT JULIET RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT JULIET | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371223323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157542828 | ||||||||
| FaxNumber: | 6517542818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 09/08/2011 | ||||||||
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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 | 8217 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 4083915 | 01 | TN | BLUECROSS BLUESHIELD | OTHER |