Healthcare Provider Details

I. General information

NPI: 1427288422
Provider Name (Legal Business Name): JENNIFER P FONTENOT DNP, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER P GRISHAM

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 JULIAN DR NE
CLEVELAND TN
37312-5433
US

IV. Provider business mailing address

4976 ALPHA LN
HIXSON TN
37343-5470
US

V. Phone/Fax

Practice location:
  • Phone: 423-250-5551
  • Fax: 423-648-1115
Mailing address:
  • Phone: 423-497-5355
  • Fax: 423-308-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14281
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: