Provider Demographics
NPI:1063475655
Name:GIESE, JEANNIE KRISTIN (DNP)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:KRISTIN
Last Name:GIESE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:KRISTIN
Other - Last Name:BOOHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, RN
Mailing Address - Street 1:6701 BAUM DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7360
Mailing Address - Country:US
Mailing Address - Phone:865-584-5727
Mailing Address - Fax:865-450-9904
Practice Address - Street 1:400 SUGARTREE LN
Practice Address - Street 2:SUITE 100
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3071
Practice Address - Country:US
Practice Address - Phone:865-615-6673
Practice Address - Fax:615-591-3204
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001126A363LF0000X
TN6536363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
500029218OtherRAILROAD MEDICARE
11509913OtherCAQH
IN200373340Medicaid
237770CMedicare PIN
11509913OtherCAQH
TB5330Medicare ID - Type Unspecified