MEDICARE: JENNIFER MICHELLE DAUGHTREY

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	363L00000X	Nurse Practitioner	APN0000026980	TN
2	363LF0000X	Family Nurse Practitioner	26980	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APN0000026980	OTHER	TN	ADVANCED PRACTICE REGISTERED NURSE
2	F1190882	OTHER		AMERICAN ACADEMY OF NURSE PRACTITIONER CERTIFICATION BOARD

General Provider Information

NPI Number	:	1265065890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MICHELLE DAUGHTREY

Provider Business Mailing Address
First Line	:	3270 OZARK CIR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-5108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5319 RINGGOLD RD STE C
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37412-3191
Country	:	US
Telephone Number	:	423-664-1120
Fax Number	:	423-760-8086

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

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/19/2025

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