Basic Information
| Provider Information | |||||||||
| NPI: | 1992847404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | NPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1113 MURFREESBORO RD | ||||||||
| Address2: | SUITE 319 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370641306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157900567 | ||||||||
| FaxNumber: | 6155958030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1113 MURFREESBORO RD | ||||||||
| Address2: | SUITE 319 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370641306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157900567 | ||||||||
| FaxNumber: | 6155958030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 12/12/2014 | ||||||||
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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 | 363LF0000X | 0000012511 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1511945 | 05 | TN | MEDICAID |