Healthcare Provider Details

I. General information

NPI: 1184175572
Provider Name (Legal Business Name): JESICA ELAINE PEARL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 KEITH ST NW STE 205
CLEVELAND TN
37312-4326
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-4915
US

V. Phone/Fax

Practice location:
  • Phone: 423-559-0444
  • Fax: 423-559-0103
Mailing address:
  • Phone: 423-238-8930
  • Fax: 423-254-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2608
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: