Healthcare Provider Details

I. General information

NPI: 1851536015
Provider Name (Legal Business Name): JENNIFER LEIGH WHITE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LEIG DAMEWOOD CRNP

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 SAINT MARY ST STE A
KNOXVILLE TN
37917-4518
US

IV. Provider business mailing address

1718 SAINT MARY ST STE A
KNOXVILLE TN
37917-4518
US

V. Phone/Fax

Practice location:
  • Phone: 865-540-4288
  • Fax: 865-637-6983
Mailing address:
  • Phone: 865-540-4288
  • Fax: 865-637-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number13667
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPN0000013667
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: