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NPI Code Detail

MEDICARE: JAYANNA KAYLEE QUALLS

MEDICARE: JAYANNA KAYLEE QUALLS
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
1164W00000XLicensed Practical NurseLPN00000097016TN

General Provider Information

NPI Number : 1073221370
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAYANNA KAYLEE QUALLS
Provider Business Mailing Address
First Line : 51 SMITH AVE
Second Line :
City : HOHENWALD
State : TN
Zip : 38462-1124
Country : US
Telephone Number : 931-796-2204
Fax Number :
Provider Business Practice Location Address
First Line : 51 SMITH AVE
Second Line :
City : HOHENWALD
State : TN
Zip : 38462-1124
Country : US
Telephone Number : 931-796-2204
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2022
Last Update Date : 11/07/2022

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Directions to “ JAYANNA KAYLEE QUALLS ” Practice Location

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