Healthcare Provider Details

I. General information

NPI: 1770120982
Provider Name (Legal Business Name): JESSICA FRENCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 OAK GROVE RD S
BUCHANAN TN
38222-5124
US

IV. Provider business mailing address

1015 KELLEY DR STE 101
PARIS TN
38242-5820
US

V. Phone/Fax

Practice location:
  • Phone: 731-336-5013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1794
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: