Healthcare Provider Details

I. General information

NPI: 1558862961
Provider Name (Legal Business Name): NOELLE MORGAN JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NOELLE ANNE MORGAN MSN, NP-C

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING PIKE STE 410
NASHVILLE TN
37205-2013
US

IV. Provider business mailing address

1235 PLYMOUTH AVE
NASHVILLE TN
37216-2211
US

V. Phone/Fax

Practice location:
  • Phone: 615-565-6763
  • Fax: 615-565-6789
Mailing address:
  • Phone: 202-441-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23803
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197406
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: