Healthcare Provider Details

I. General information

NPI: 1982909370
Provider Name (Legal Business Name): JESSICA EASLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 OLD HICKORY BLVD APT 709
NASHVILLE TN
37209-5173
US

IV. Provider business mailing address

510 OLD HICKORY BLVD APT 709
NASHVILLE TN
37209-5173
US

V. Phone/Fax

Practice location:
  • Phone: 931-239-7057
  • Fax:
Mailing address:
  • Phone: 931-239-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: