MEDICARE: JENNIFER ASHLEY PETERSON TAYLOR PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	39087	TN

General Provider Information

NPI Number	:	1457248874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ASHLEY PETERSON TAYLOR PMHNP

Provider Business Mailing Address
First Line	:	2700 S ROAN ST STE 435
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-7587
Country	:	US
Telephone Number	:	615-236-2171
Fax Number	:	423-497-1483

Provider Business Practice Location Address
First Line	:	2700 S ROAN ST STE 206
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-7557
Country	:	US
Telephone Number	:	615-236-2171
Fax Number	:	615-236-2171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/23/2026

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