Healthcare Provider Details

I. General information

NPI: 1508309766
Provider Name (Legal Business Name): JESSICA MILLRANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W MAIN ST
CAMDEN TN
38320-1609
US

IV. Provider business mailing address

190 W MAIN ST
CAMDEN TN
38320-1609
US

V. Phone/Fax

Practice location:
  • Phone: 731-213-2662
  • Fax: 731-213-2539
Mailing address:
  • Phone: 731-213-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000021860
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: