Healthcare Provider Details

I. General information

NPI: 1235406893
Provider Name (Legal Business Name): JENNIFER RENAE GUFFEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N SPRINGS RD
RED BOILING SPRINGS TN
37150-3810
US

IV. Provider business mailing address

606 N SPRINGS RD
RED BOILING SPRINGS TN
37150-3810
US

V. Phone/Fax

Practice location:
  • Phone: 615-735-0242
  • Fax: 615-735-8250
Mailing address:
  • Phone: 615-735-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1777-8701
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: