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General NPI Number Information
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NPI Number | 1255985396
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Entity Type | Individual
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Provider Name | JESSICA R CHITTUM FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 779 HIGHWAY 63 STE 1
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City | CUMBERLAND GAP
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State | TN
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Zip | 37724-4116
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Country | US
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Telephone | 423-919-9886
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Fax | 423-919-9887
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Provider Business Mailing Address
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Address Line | PO BOX 119
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City | HARROGATE
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State | TN
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Zip | 37752-0119
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Country | US
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Telephone | 423-489-2300
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Fax | 423-919-9887
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0000026201
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License Number State | TN
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