Provider Demographics
NPI:1144412958
Name:EVANGELIST, JENNIFER LYNN (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:EVANGELIST
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-5564
Mailing Address - Country:US
Mailing Address - Phone:615-293-1500
Mailing Address - Fax:
Practice Address - Street 1:1437 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:TN
Practice Address - Zip Code:37073-5564
Practice Address - Country:US
Practice Address - Phone:615-293-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011558364SM0705X
TN55974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ34654Medicare UPIN