Healthcare Provider Details

I. General information

NPI: 1982737912
Provider Name (Legal Business Name): JODY WIDNER HENDERSON RN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODY YVONNE WIDNER RN

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 WESTERN AVE
KNOXVILLE TN
37921
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-0406
  • Fax: 865-544-0480
Mailing address:
  • Phone: 423-317-9344
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN50310
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: