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General NPI Number Information
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NPI Number | 1770113136
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Entity Type | Individual
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Provider Name | JAIME LEE MCCLELLAN APRN
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Gender | Female
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 2012 CHILHOWEE MEDICAL PARK
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City | MARYVILLE
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State | TN
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Zip | 37804-5285
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Country | US
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Telephone | 865-205-6449
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Fax |
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Provider Business Mailing Address
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Address Line | 1787 VETERANS BLVD
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City | SEVIERVILLE
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State | TN
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Zip | 37862-6945
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Country | US
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Telephone | 423-470-3416
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 27139
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License Number State | TN
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