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General NPI Number Information
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NPI Number | 1487071171
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Entity Type | Organization
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Legal Business Name | JWSCHEPERSMD
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 207 N BOONE ST SUITE 28
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City | JOHNSON CITY
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State | TN
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Zip | 37604-5675
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Country | US
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Telephone | 423-930-8390
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Fax | 888-965-5582
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Provider Business Mailing Address
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Address Line | 207 N BOONE ST SUITE 28
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City | JOHNSON CITY
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State | TN
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Zip | 37604-5675
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Country | US
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Telephone | 423-930-8390
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Fax | 888-965-5582
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Authorized Official
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Title or Position | ADMINISTRATOR/PSYCHIATRIST
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Name | DR. JENNIFER WISDOM-SCHEPERS
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Credential | M.D.
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Telephone | 423-930-8390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 39325
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License Number State | TN
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