MEDICARE: MR. JERRY RAY HAMM APN, FNP-BC

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	APN0000014464	TN

General Provider Information

NPI Number	:	1720313521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERRY RAY HAMM APN, FNP-BC

Provider Business Mailing Address
First Line	:	8510 WILKINSVILLE RD
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-1537
Country	:	US
Telephone Number	:	901-872-3114
Fax Number	:	901-872-3116

Provider Business Practice Location Address
First Line	:	8510 WILKINSVILLE RD
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-1537
Country	:	US
Telephone Number	:	901-872-3114
Fax Number	:	901-872-3116

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

Provider Enumeration Date	:	10/12/2009
Last Update Date	:	04/02/2014

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