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General NPI Number Information
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NPI Number | 1326038027
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Entity Type | Individual
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Provider Name | DONNA JENELL PEASE ANP/GNP,BC-ADM,CDE
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Gender | Female
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 650 JOEL DR
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5318
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Country | US
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Telephone | 270-798-8328
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Fax | 270-798-8112
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Provider Business Mailing Address
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Address Line | 407 LAKE POINTE DR
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City | CLARKSVILLE
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State | TN
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Zip | 37043-2877
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Country | US
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Telephone | 931-801-9166
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Fax |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 37182
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 37182
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License Number State | TN
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