MEDICARE: MRS. JENNIFER C COMPTON P.A.

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	363A00000X	Physician Assistant	PA0000000275	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080194591	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	830342546	OTHER	TN	JOHN DEERE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	246269	OTHER	VA	ANTHEM BCBS VA
6	4059748	OTHER	TN	BCBS TN

General Provider Information

NPI Number	:	1467457341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER C COMPTON P.A.

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37662-0009
Country	:	US
Telephone Number	:	423-857-2066
Fax Number	:	423-390-3339

Provider Business Practice Location Address
First Line	:	4848 FORT HENRY DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37663-3347
Country	:	US
Telephone Number	:	423-857-2066
Fax Number	:	423-857-2066

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/29/2017

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Directions to “ MRS. JENNIFER C COMPTON P.A.” Practice Location

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