MEDICARE: JIMMY WAYNE CHEEKS JR. 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	363LF0000X	Family Nurse Practitioner	8217	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4083915	OTHER	TN	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1447282611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY WAYNE CHEEKS JR. NP

Provider Business Mailing Address
First Line	:	3024 BUSINESS PARK CIR
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-3132
Country	:	US
Telephone Number	:	615-239-2018
Fax Number	:

Provider Business Practice Location Address
First Line	:	754 N MOUNT JULIET RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3323
Country	:	US
Telephone Number	:	615-754-2828
Fax Number	:	651-754-2818

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/03/2023

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