MEDICARE: JESSICA MARIE HUENING FNP-C

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	363LF0000X	Family Nurse Practitioner	34960	TN

General Provider Information

NPI Number	:	1407628134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE HUENING FNP-C

Provider Business Mailing Address
First Line	:	399 WILCOX CIR
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-4436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 E ANDREW JOHNSON HWY STE 1
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-0968
Country	:	US
Telephone Number	:	423-820-0033
Fax Number	:

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

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	10/25/2023

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