MEDICARE: MS. JESSICA MARIE PRICE NP

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	363LP2300X	Primary Care Nurse Practitioner	222076	TN

General Provider Information

NPI Number	:	1417489717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA MARIE PRICE NP

Provider Business Mailing Address
First Line	:	264 NEW SHACKLE ISLAND RD
Second Line	:	STE 107
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2481
Country	:	US
Telephone Number	:	615-361-6713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 CAPITAL FUNDS CT
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217-3937
Country	:	US
Telephone Number	:	615-361-6713
Fax Number	:

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

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	01/31/2018

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