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NPI Code Detail

MEDICARE: JACK KEISER FNP

MEDICARE:   JACK  KEISER  FNP
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 Practitioner95018639CA
2363LF0000XFamily Nurse PractitionerAPRN11042755FL
3363LF0000XFamily Nurse Practitioner24976TN

General Provider Information

NPI Number : 1104393651
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK KEISER FNP
Provider Business Mailing Address
First Line : 9300 ARROWHEAD CT
Second Line :
City : BRENTWOOD
State : TN
Zip : 37027-7477
Country : US
Telephone Number : 615-775-7720
Fax Number :
Provider Business Practice Location Address
First Line : 41 PEABODY ST
Second Line :
City : NASHVILLE
State : TN
Zip : 37210-2125
Country : US
Telephone Number : 615-420-7515
Fax Number : 615-420-7515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2018
Last Update Date : 04/16/2026

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