Healthcare Provider Details

I. General information

NPI: 1306554365
Provider Name (Legal Business Name): JESSICA LYNN BONNER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ALCOA HWY STE 435
KNOXVILLE TN
37920-1520
US

IV. Provider business mailing address

115 LINWOOD LN
MARYVILLE TN
37804-3625
US

V. Phone/Fax

Practice location:
  • Phone: 865-263-2400
  • Fax:
Mailing address:
  • Phone: 865-696-6921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number31137
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: