MEDICARE: MRS. JESSICA PRATT FNP

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	27252	TN

General Provider Information

NPI Number	:	1578197836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA PRATT FNP

Provider Business Mailing Address
First Line	:	512 MARBURY RD
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2142
Country	:	US
Telephone Number	:	931-581-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 WILLOW DR
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-2438
Country	:	US
Telephone Number	:	931-409-2194
Fax Number	:

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

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	11/12/2020

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