Healthcare Provider Details

I. General information

NPI: 1760052534
Provider Name (Legal Business Name): JENNIFER CHRISTINE SHINKLE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S CHARLES G SEIVERS BLVD
CLINTON TN
37716-3929
US

IV. Provider business mailing address

350 S CHARLES G SEIVERS BLVD
CLINTON TN
37716-3929
US

V. Phone/Fax

Practice location:
  • Phone: 865-290-2313
  • Fax: 865-290-2314
Mailing address:
  • Phone: 865-290-2313
  • Fax: 865-290-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA161607
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number34772
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberA161607
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: