Healthcare Provider Details

I. General information

NPI: 1780948612
Provider Name (Legal Business Name): JENNIFER ANN ONEAL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 1ST ST
MONTEAGLE TN
37356
US

IV. Provider business mailing address

21 1ST ST
MONTEAGLE TN
37356
US

V. Phone/Fax

Practice location:
  • Phone: 931-924-8000
  • Fax: 931-924-8001
Mailing address:
  • Phone: 931-924-8000
  • Fax: 931-924-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16697
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: