Healthcare Provider Details

I. General information

NPI: 1639822372
Provider Name (Legal Business Name): JENNIFER LOU MCNIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2661 BIRDSONG AVE
MURFREESBORO TN
37129-1917
US

IV. Provider business mailing address

2661 BIRDSONG AVE
MURFREESBORO TN
37129-1917
US

V. Phone/Fax

Practice location:
  • Phone: 615-278-0975
  • Fax: 770-723-8576
Mailing address:
  • Phone: 615-556-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number70951
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: