Healthcare Provider Details

I. General information

NPI: 1447264361
Provider Name (Legal Business Name): JENNIFER C. WISDOM-SCHEPERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER C. WISDOM-SCHEPERS

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 BROWNS MILL RD
JOHNSON CITY TN
37604-1417
US

IV. Provider business mailing address

3114 BROWNS MILL RD
JOHNSON CITY TN
37604-1417
US

V. Phone/Fax

Practice location:
  • Phone: 423-631-0432
  • Fax: 423-631-0284
Mailing address:
  • Phone: 423-631-0432
  • Fax: 423-631-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39325
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: