Healthcare Provider Details

I. General information

NPI: 1235642000
Provider Name (Legal Business Name): JENIFER JILL STEVENS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CHERRY AVE
COOKEVILLE TN
38501-2521
US

IV. Provider business mailing address

105 CHERRY AVE
COOKEVILLE TN
38501-2521
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-5811
  • Fax: 931-526-1497
Mailing address:
  • Phone: 931-528-5811
  • Fax: 931-526-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23561
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: