=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275147258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA ADRIANNE WHEELER FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2020
-----------------------------------------------------
Last Update Date | 10/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1532 W ANDREW JOHNSON HWY
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-616-0705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 319 HARRISTOWN RD
-----------------------------------------------------
City | BULLS GAP
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37711-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-754-7276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 27732
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------