Healthcare Provider Details

I. General information

NPI: 1285909234
Provider Name (Legal Business Name): JAIMA B GEMMELL F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIMA B PENNINGTON FNP

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W STONE DR STE 3A
KINGSPORT TN
37660-3365
US

IV. Provider business mailing address

PO BOX 9
KINGSPORT TN
37662-0009
US

V. Phone/Fax

Practice location:
  • Phone: 423-392-6200
  • Fax: 423-392-6593
Mailing address:
  • Phone: 423-857-2093
  • Fax: 423-390-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30633
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16570
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: