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General NPI Number Information
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NPI Number | 1861796344
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Entity Type | Individual
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Provider Name | MRS. JEANNE SILER LILLY
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Gender | Female
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Dates
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Enumeration Date | 12/27/2010
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 204 DOGWOOD LANE
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City | MOUNTAIN HOME
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State | TN
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Zip | 37684-4000
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Country | US
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Telephone | 423-926-1171
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 322
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City | MOUNTAIN HOME
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State | TN
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Zip | 37684-0322
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Country | US
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Telephone | 423-926-1171
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 0000000064
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 6761
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License Number State | NC
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