MEDICARE: JESSICA HUSTON

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	207RC0000X	Cardiovascular Disease Physician	55053	TN
2	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	MD470490	PA

General Provider Information

NPI Number	:	1073874616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HUSTON

Provider Business Mailing Address
First Line	:	1106 CHICKERING PARK DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-4508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 HARDING PIKE STE 450
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-2005
Country	:	US
Telephone Number	:	615-222-3945
Fax Number	:

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

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	08/16/2024

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