Provider Demographics
NPI:1043608425
Name:PERNELL, JESSICA VINCENT
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:VINCENT
Last Name:PERNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CHARLOTTE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2032
Mailing Address - Country:US
Mailing Address - Phone:615-320-0900
Mailing Address - Fax:615-320-7623
Practice Address - Street 1:2001 CHARLOTTE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2032
Practice Address - Country:US
Practice Address - Phone:615-320-0900
Practice Address - Fax:615-320-7623
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000019222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily