1336281609 NPI number — MS. JENNIFER WALKER WEBER

Table of content: MS. JENNIFER WALKER WEBER (NPI 1336281609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336281609 NPI number — MS. JENNIFER WALKER WEBER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBER
Provider First Name:
JENNIFER
Provider Middle Name:
WALKER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALKER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
D.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336281609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 RICHARD JONES RD.
Provider Second Line Business Mailing Address:
STE. 220
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-383-2400
Provider Business Mailing Address Fax Number:
615-383-1948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1756 POPPS FERRY RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39532-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-865-3200
Provider Business Practice Location Address Fax Number:
228-575-1600
Provider Enumeration Date:
02/13/2007

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:  APN10802 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 889212 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3648434 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".