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General NPI Number Information
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NPI Number | 1629126321
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Entity Type | Individual
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Provider Name | JACKIE A CHURCH APN
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 344 OVERLOOK DR STE 200
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City | LEBANON
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State | VA
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Zip | 24266-3436
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Country | US
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Telephone | 276-883-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-952-2111
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Fax | 423-282-1657
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5018685
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 143764
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN12537
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024187900
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License Number State | VA
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