Healthcare Provider Details

I. General information

NPI: 1508641622
Provider Name (Legal Business Name): JESSICA KIMSEY HOBBS DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA COULTER

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWTHORNE LN
CHARLOTTE NC
28204-2515
US

IV. Provider business mailing address

5810 MOUNTAIN PASS DR
OOLTEWAH TN
37363-9200
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-4000
  • Fax:
Mailing address:
  • Phone: 423-364-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number144832
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: