Healthcare Provider Details

I. General information

NPI: 1407628134
Provider Name (Legal Business Name): JESSICA MARIE HUENING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 E ANDREW JOHNSON HWY STE 1
GREENEVILLE TN
37745-0968
US

IV. Provider business mailing address

399 WILCOX CIR
JONESBOROUGH TN
37659-4436
US

V. Phone/Fax

Practice location:
  • Phone: 423-820-0033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number34960
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: