1710038989 NPI number — MRS. JENNIFER LEE GERBER F.N.P.

Table of content: MRS. JENNIFER LEE GERBER F.N.P. (NPI 1710038989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710038989 NPI number — MRS. JENNIFER LEE GERBER F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERBER
Provider First Name:
JENNIFER
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710038989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAVERLY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37185-0270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-296-7052
Provider Business Mailing Address Fax Number:
931-296-3566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 HILLWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAVERLY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37185-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-296-7052
Provider Business Practice Location Address Fax Number:
931-296-3566
Provider Enumeration Date:
01/15/2007

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: 363LF0000X , with the licence number:  RN0000105859 , 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)

  • Identifier: 3904781 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223121700 . This is a "DEPT OF LABOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4045784 . This is a "BLUE CROSS BLUE SHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".