Healthcare Provider Details

I. General information

NPI: 1063804532
Provider Name (Legal Business Name): JAY ANTHONY PASSMORE MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 GUNBARREL RD STE 400
CHATTANOOGA TN
37421-4987
US

IV. Provider business mailing address

2305 CHAMBLISS AVE NW
CLEVELAND TN
37311-3847
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-5693
  • Fax: 423-778-8543
Mailing address:
  • Phone: 423-559-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number132749
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19928
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: