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General NPI Number Information
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NPI Number | 1265517197
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Entity Type | Individual
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Provider Name | JENNIE L. WALLS FNP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | DAVID CROCKETT HIGH SCHOOL HEALTH CLINIC 684 OLD STATE ROUTE 34
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City | JONESBOROUGH
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State | TN
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Zip | 37659
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Country | US
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Telephone | 423-753-0057
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70403
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City | JOHNSON CITY
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State | TN
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Zip | 37614-1703
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Country | US
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Telephone | 423-439-4078
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Fax | 423-439-4060
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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 | APN5169
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License Number State | TN
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