Healthcare Provider Details

I. General information

NPI: 1023397957
Provider Name (Legal Business Name): JACQUELINE LEE SWALLOWS FNP-BC, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACKIE LEE SWALLOWS FNP-BC, NP-C

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 BROAD ST
BAXTER TN
38544-5117
US

IV. Provider business mailing address

1780 WINDLE COMMUNITY RD
COOKEVILLE TN
38506-7910
US

V. Phone/Fax

Practice location:
  • Phone: 931-858-2116
  • Fax: 931-858-2117
Mailing address:
  • Phone: 931-319-9335
  • Fax: 931-858-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16020
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: