1851441679 NPI number — MRS. JILL K DENNEY PA-C

Table of content: MRS. JILL K DENNEY PA-C (NPI 1851441679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851441679 NPI number — MRS. JILL K DENNEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNEY
Provider First Name:
JILL
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1851441679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 S WEBB AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROSSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38555-8452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-484-5379
Provider Business Mailing Address Fax Number:
931-484-5946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 S WEBB AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38555-8452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-484-5379
Provider Business Practice Location Address Fax Number:
931-484-5946
Provider Enumeration Date:
01/12/2007

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: 363A00000X , with the licence number:  000260 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA260 , 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: 200006546 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4342947 . This is a "BCBS TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00260 . This is a "STATE LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 12407183 . This is a "CAQH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1530022 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q000217 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4084528 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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