Healthcare Provider Details

I. General information

NPI: 1891602942
Provider Name (Legal Business Name): MISTY SUNDAY JENKINS MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-6035
US

IV. Provider business mailing address

3732 BROWNS MILL RD
JOHNSON CITY TN
37615-4507
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number111979
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: