Healthcare Provider Details

I. General information

NPI: 1922380534
Provider Name (Legal Business Name): JESSI MARRI STEVE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2011
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MOUSE CREEK RD NW
CLEVELAND TN
37312-3840
US

IV. Provider business mailing address

170 MOUSE CREEK RD NW
CLEVELAND TN
37312-3840
US

V. Phone/Fax

Practice location:
  • Phone: 423-458-1426
  • Fax: 423-790-1276
Mailing address:
  • Phone: 423-458-1426
  • Fax: 423-790-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000659
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16093
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: