Healthcare Provider Details

I. General information

NPI: 1043583081
Provider Name (Legal Business Name): JESSICA HITCHCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E SPRING ST
COOKEVILLE TN
38501-3208
US

IV. Provider business mailing address

136 E SPRING ST
COOKEVILLE TN
38501-3208
US

V. Phone/Fax

Practice location:
  • Phone: 931-854-1011
  • Fax: 931-854-1335
Mailing address:
  • Phone: 931-854-1011
  • Fax: 931-854-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: