Healthcare Provider Details

I. General information

NPI: 1245672674
Provider Name (Legal Business Name): JESSICA M YAUDES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2974 BAKER HWY
HUNTSVILLE TN
37756-3806
US

IV. Provider business mailing address

470 INDUSTRIAL LN
ONEIDA TN
37841-6294
US

V. Phone/Fax

Practice location:
  • Phone: 423-663-9200
  • Fax: 423-663-3389
Mailing address:
  • Phone: 423-286-4141
  • Fax: 423-286-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN17825
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: