Provider Demographics
NPI:1023397957
Name:SWALLOWS, JACQUELINE LEE (FNP-BC, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LEE
Last Name:SWALLOWS
Suffix:
Gender:F
Credentials:FNP-BC, NP-C
Other - Prefix:MRS
Other - First Name:JACKIE
Other - Middle Name:LEE
Other - Last Name:SWALLOWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC, NP-C
Mailing Address - Street 1:1780 WINDLE COMMUNITY RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-7910
Mailing Address - Country:US
Mailing Address - Phone:931-319-9335
Mailing Address - Fax:931-858-2117
Practice Address - Street 1:319 BROAD ST
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:TN
Practice Address - Zip Code:38544-5117
Practice Address - Country:US
Practice Address - Phone:931-858-2116
Practice Address - Fax:931-858-2117
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily