Healthcare Provider Details

I. General information

NPI: 1336580190
Provider Name (Legal Business Name): JENNIFER DUNN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 US HIGHWAY 64 STE 105
LAKELAND TN
38002-3011
US

IV. Provider business mailing address

30 BURTON HILLS BLVD STE 175
NASHVILLE TN
37215-6403
US

V. Phone/Fax

Practice location:
  • Phone: 901-213-0100
  • Fax: 901-213-0101
Mailing address:
  • Phone: 615-988-2014
  • Fax: 615-208-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR884862
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17697
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: