Healthcare Provider Details

I. General information

NPI: 1396209805
Provider Name (Legal Business Name): JAY ROBERT POPE F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 S HIGHLAND AVE
JACKSON TN
38301-7799
US

IV. Provider business mailing address

PO BOX 400
JACKSON TN
38302-0400
US

V. Phone/Fax

Practice location:
  • Phone: 731-422-0213
  • Fax: 731-256-5593
Mailing address:
  • Phone: 731-423-8697
  • Fax: 731-423-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number25428
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25428
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: