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General NPI Number Information
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NPI Number | 1619689981
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Entity Type | Organization
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Legal Business Name | CPESN TENNESSEE
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 1000 MONARCH PT
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City | GREENEVILLE
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State | TN
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Zip | 37745-4656
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Country | US
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Telephone | 423-817-0355
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 MONARCH PT
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City | GREENEVILLE
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State | TN
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Zip | 37745-4656
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING NETWORK FACILITATOR
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Name | JESSICS ROBINSON
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Credential | PHARMD
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Telephone | 423-817-0355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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