1629236708 NPI number — MRS. JENNIFER THOMAS CASEY APRN

Table of content: MRS. JENNIFER THOMAS CASEY APRN (NPI 1629236708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629236708 NPI number — MRS. JENNIFER THOMAS CASEY APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASEY
Provider First Name:
JENNIFER
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
ANDERSON
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629236708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 EAGLES NEST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37148-2045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-799-1447
Provider Business Mailing Address Fax Number:
615-799-6350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 PARMAN PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-799-1447
Provider Business Practice Location Address Fax Number:
615-799-6350
Provider Enumeration Date:
05/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  APN0000013415 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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