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General NPI Number Information
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NPI Number | 1942750773
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Entity Type | Organization
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Legal Business Name | JESSICA LIVINGSTON MSN APRN
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 3720 N BROADWAY ST
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City | KNOXVILLE
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State | TN
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Zip | 37917-3120
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Country | US
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Telephone | 865-315-8353
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Fax |
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Provider Business Mailing Address
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Address Line | 3720 N BROADWAY ST
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City | KNOXVILLE
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State | TN
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Zip | 37917-3120
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Country | US
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Telephone | 865-315-8353
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Fax |
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Authorized Official
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Title or Position | OWNER/ CEO
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Name | JESSICA LIVINGSTON
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Credential |
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Telephone | 865-405-1358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 13406
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License Number State | TN
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