Healthcare Provider Details

I. General information

NPI: 1093116741
Provider Name (Legal Business Name): JESSICA B WHALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ALCOA HWY E210
KNOXVILLE TN
37920-2244
US

IV. Provider business mailing address

PO BOX 440010
NASHVILLE TN
37244-0010
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-7471
  • Fax: 865-305-6563
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19164
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: