=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598223414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNI A. GERWIN FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2019
-----------------------------------------------------
Last Update Date | 10/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10622 CHAPMAN HWY
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37865-4703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-773-0327
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 CARR RD
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37865-3618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-749-8209
-----------------------------------------------------
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 | 30905
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------