Healthcare Provider Details

I. General information

NPI: 1952855926
Provider Name (Legal Business Name): JESSICA EVANS PATRICK F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEMORIAL DR
DALTON GA
30720-2529
US

IV. Provider business mailing address

1431 CENTERPOINT BLVD STE 100
KNOXVILLE TN
37932-1983
US

V. Phone/Fax

Practice location:
  • Phone: 706-272-6158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN209632
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: