=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063830156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER JENKINS APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2014
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 W MORRIS BLVD SUITE130
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813-2283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-581-3939
-----------------------------------------------------
Fax | 423-318-2200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 W MORRIS BLVD STE 130
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813-2255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-581-3939
-----------------------------------------------------
Fax | 423-318-2200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 18612
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------