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NPI Code Detail

MEDICARE: MRS. JACQUELINE LEE SWALLOWS FNP-BC, NP-C

MEDICARE: MRS. JACQUELINE LEE SWALLOWS FNP-BC, NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner16020TN

General Provider Information

NPI Number : 1023397957
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACQUELINE LEE SWALLOWS FNP-BC, NP-C
Provider Business Mailing Address
First Line : 1780 WINDLE COMMUNITY RD
Second Line :
City : COOKEVILLE
State : TN
Zip : 38506-7910
Country : US
Telephone Number : 931-319-9335
Fax Number : 931-858-2117
Provider Business Practice Location Address
First Line : 319 BROAD ST
Second Line :
City : BAXTER
State : TN
Zip : 38544-5117
Country : US
Telephone Number : 931-858-2116
Fax Number : 931-858-2117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2011
Last Update Date : 07/18/2019

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