MEDICARE: JORDAN BOLLINGER

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
1	163W00000X	Registered Nurse	227419	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	78827	NM
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	30045	TN

General Provider Information

NPI Number	:	1063030369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN BOLLINGER

Provider Business Mailing Address
First Line	:	550 FORT SUMMIT WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37915-2146
Country	:	US
Telephone Number	:	865-679-0764
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 FORT SUMMIT WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37915-2146
Country	:	US
Telephone Number	:	865-679-0764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	10/16/2024

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Directions to “ JORDAN BOLLINGER ” Practice Location

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