Healthcare Provider Details

I. General information

NPI: 1033427695
Provider Name (Legal Business Name): JAMIE MITCHELL GILES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 DUTCH VALLEY RD
CLINTON TN
37716-5117
US

IV. Provider business mailing address

1809 DUTCH VALLEY RD
CLINTON TN
37716-5104
US

V. Phone/Fax

Practice location:
  • Phone: 865-435-6056
  • Fax:
Mailing address:
  • Phone: 865-435-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number0000165533
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15478
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: