Healthcare Provider Details

I. General information

NPI: 1558492306
Provider Name (Legal Business Name): JENIPHER E CHANEY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 OLD HWY 51 SUITE C
BRIGHTON TN
38011
US

IV. Provider business mailing address

1880 OLD HWY 51
BRIGHTON TN
38011
US

V. Phone/Fax

Practice location:
  • Phone: 901-837-7979
  • Fax: 901-837-7999
Mailing address:
  • Phone: 901-837-7979
  • Fax: 901-837-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPN0000012536
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: