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NPI Code Detail

MEDICARE: MRS. JESSICA FAY

MEDICARE: MRS. JESSICA FAY
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
1363LF0000XFamily Nurse PractitionerAPN0000012538TN

General Provider Information

NPI Number : 1477681534
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA FAY
Provider Business Mailing Address
First Line : PO BOX 772
Second Line :
City : WOONSOCKET
State : RI
Zip : 02895-0784
Country : US
Telephone Number : 612-659-7111
Fax Number : 612-659-7101
Provider Business Practice Location Address
First Line : 735 HARDING PL
Second Line :
City : NASHVILLE
State : TN
Zip : 37211-4357
Country : US
Telephone Number : 612-659-7111
Fax Number : 612-659-7101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 04/24/2013

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