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General NPI Number Information
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NPI Number | 1104453364
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Entity Type | Individual
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Provider Name | JERICA KRISTIN NICOLE ROBERTSON DO
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 11606 CHAPMAN HWY STE 2
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City | SEYMOUR
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State | TN
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Zip | 37865-5270
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Country | US
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Telephone | 865-609-6980
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Fax | 865-609-6982
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Provider Business Mailing Address
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Address Line | 11606 CHAPMAN HWY STE 2
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City | SEYMOUR
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State | TN
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Zip | 37865-5270
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Country | US
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Telephone | 865-609-6980
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Fax | 865-609-6982
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0000005417
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License Number State | TN
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