MEDICARE: JESSICA DIANE PHELPS 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	363LF0000X	Family Nurse Practitioner	33424	TN

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

General Provider Information

NPI Number	:	1669904801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DIANE PHELPS FNP

Provider Business Mailing Address
First Line	:	PO BOX 381468
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-1468
Country	:	US
Telephone Number	:	901-377-8219
Fax Number	:	901-328-1355

Provider Business Practice Location Address
First Line	:	1115B DOW ST
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37130-2487
Country	:	US
Telephone Number	:	615-896-6996
Fax Number	:	615-896-6985

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

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	03/05/2026

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