Healthcare Provider Details

I. General information

NPI: 1942169966
Provider Name (Legal Business Name): TWISTED ROOTS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 NORTHPARK DR STE 2C
JOHNSON CITY TN
37604-3127
US

IV. Provider business mailing address

823 LIBERTY CHURCH RD
KINGSPORT TN
37663-4614
US

V. Phone/Fax

Practice location:
  • Phone: 423-367-7688
  • Fax: 877-682-3703
Mailing address:
  • Phone: 423-218-8459
  • Fax: 877-682-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVA M JESSEE
Title or Position: OWNER
Credential: FNP-BC
Phone: 423-367-7688