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General NPI Number Information
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NPI Number | 1760255681
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Entity Type | Individual
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Provider Name | MCKINLEY JACKSON WAUGH DNP, CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 900 E 3RD ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2101
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Country | US
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Telephone | 423-778-5910
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Fax |
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Provider Business Mailing Address
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Address Line | 1286 NEYLAND CIR
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City | HIXSON
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State | TN
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Zip | 37343-6901
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Country | US
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Telephone | 706-691-5547
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 233323
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 34655
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License Number State | TN
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