Healthcare Provider Details

I. General information

NPI: 1174961445
Provider Name (Legal Business Name): JEWELL ANN KAYLOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHWAY 76
CLARKSVILLE TN
37043-8405
US

IV. Provider business mailing address

PO BOX 30459
CLARKSVILLE TN
37040-0008
US

V. Phone/Fax

Practice location:
  • Phone: 931-245-1150
  • Fax: 931-245-1153
Mailing address:
  • Phone: 931-245-1150
  • Fax: 931-245-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number150129
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNURR32203
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number748877
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number634916
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21503
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008234
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: