Healthcare Provider Details

I. General information

NPI: 1710893847
Provider Name (Legal Business Name): JESSICA IRENE OSBORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 E BROADWAY AVE
MARYVILLE TN
37804-2916
US

IV. Provider business mailing address

200 TECH CENTER DR
KNOXVILLE TN
37912-2747
US

V. Phone/Fax

Practice location:
  • Phone: 865-681-6990
  • Fax: 865-637-6342
Mailing address:
  • Phone: 865-637-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: