Healthcare Provider Details

I. General information

NPI: 1598929572
Provider Name (Legal Business Name): JACQUELYNN WHITE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 23RD AVE N
NASHVILLE TN
37203-1503
US

IV. Provider business mailing address

1492 BERN DR
SPRING HILL TN
37174-7172
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-7781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN0000084901
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: