Provider Demographics
NPI:1033841705
Name:STEWART, JESSICA MEGAN (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MEGAN
Last Name:STEWART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5991 HIGHWAY 161
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-6738
Mailing Address - Country:US
Mailing Address - Phone:615-533-8919
Mailing Address - Fax:
Practice Address - Street 1:5991 HIGHWAY 161
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-6738
Practice Address - Country:US
Practice Address - Phone:615-533-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily