Healthcare Provider Details

I. General information

NPI: 1063058667
Provider Name (Legal Business Name): ABBY ELIZABETH JERROLDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY ELIZABETH SMITH NP

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 ENOCH BLVD
SAVANNAH TN
38372-2240
US

IV. Provider business mailing address

PO BOX 655
SAVANNAH TN
38372-0655
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-2300
  • Fax: 731-925-2157
Mailing address:
  • Phone: 731-925-2300
  • Fax: 731-925-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26684
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: