Healthcare Provider Details

I. General information

NPI: 1083334593
Provider Name (Legal Business Name): JENNIFER BETH HUFFMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 BRISTOL HWY
JOHNSON CITY TN
37601
US

IV. Provider business mailing address

2717 EAST OAKLAND AVENUE
JOHNSON CITY TN
37601-1843
US

V. Phone/Fax

Practice location:
  • Phone: 866-779-1964
  • Fax: 866-779-1964
Mailing address:
  • Phone: 866-779-1964
  • Fax: 866-779-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024185573
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32323
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32323
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: