Healthcare Provider Details

I. General information

NPI: 1821629320
Provider Name (Legal Business Name): JESSIE FORGIONE BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

169 PICARDY ST
MEMPHIS TN
38111-1925
US

V. Phone/Fax

Practice location:
  • Phone: 888-226-4343
  • Fax:
Mailing address:
  • Phone: 901-230-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number0000211988
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number30786
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: