Healthcare Provider Details

I. General information

NPI: 1841298049
Provider Name (Legal Business Name): JEWEL MCMILLEN BIRDWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 W 5TH AVE
KNOXVILLE TN
37917-7109
US

IV. Provider business mailing address

6350 W A J HWY DEPARTMENT 100
TALBOTT TN
37877
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-2104
  • Fax: 865-525-2212
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN35903
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN5190
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: