Basic Information
| Provider Information | |||||||||
| NPI: | 1558862961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | NOELLE | ||||||||
| MiddleName: | MORGAN | ||||||||
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| OtherLastName: | MORGAN | ||||||||
| OtherFirstName: | NOELLE | ||||||||
| OtherMiddleName: | ANNE | ||||||||
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| OtherCredential: | MSN, NP-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1235 PLYMOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372162211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024417320 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4230 HARDING PIKE STE 410 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155656763 | ||||||||
| FaxNumber: | 6155656789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2018 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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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 | 163W00000X | 197406 | TN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 23803 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.