Healthcare Provider Details

I. General information

NPI: 1902105695
Provider Name (Legal Business Name): JENNIFER LEANNE HUFFSTETLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 HUNTERS XING
ALCOA TN
37701-1849
US

IV. Provider business mailing address

701 MORGANTON SQUARE DR
MARYVILLE TN
37801-4796
US

V. Phone/Fax

Practice location:
  • Phone: 865-980-5070
  • Fax: 865-980-5075
Mailing address:
  • Phone: 865-273-1752
  • Fax: 865-273-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000127106
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN015767
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: