Provider Demographics
NPI:1083657373
Name:JENKINS, JANICE TEAGUE (FNP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:TEAGUE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:FNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6350 W A J HWY
Mailing Address - Street 2:DEPARTMENT 100
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:501 ADESA BLVD
Practice Address - Street 2:SUITE A150
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771
Practice Address - Country:US
Practice Address - Phone:865-986-8082
Practice Address - Fax:865-986-5890
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN 5832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S44763Medicare UPIN