Provider Demographics
NPI:1033423074
Name:NELSON, JENNIFER A (CPNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OTIS SMITH DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8940
Mailing Address - Country:US
Mailing Address - Phone:931-553-6666
Mailing Address - Fax:931-553-4006
Practice Address - Street 1:111 OTIS SMITH DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8940
Practice Address - Country:US
Practice Address - Phone:931-553-6666
Practice Address - Fax:931-553-4006
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13244363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics