Healthcare Provider Details

I. General information

NPI: 1164308532
Provider Name (Legal Business Name): JESSIE ERYN OBRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 HOBBS DR
WHITE HOUSE TN
37188-7902
US

IV. Provider business mailing address

409 HOBBS DR
WHITE HOUSE TN
37188-7902
US

V. Phone/Fax

Practice location:
  • Phone: 188-362-5272
  • Fax:
Mailing address:
  • Phone: 615-428-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48965
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: