Provider Demographics
NPI:1104393651
Name:KEISER, JACK (FNP)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:KEISER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 ARROWHEAD CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7477
Mailing Address - Country:US
Mailing Address - Phone:615-775-7720
Mailing Address - Fax:
Practice Address - Street 1:41 PEABODY ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2125
Practice Address - Country:US
Practice Address - Phone:615-420-7515
Practice Address - Fax:615-420-7515
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily