Provider Demographics
NPI:1164415287
Name:JANS, JODI ANN (PA C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ANN
Last Name:JANS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 440547
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0547
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6188
Practice Address - Street 1:1940 ALCOA HWY
Practice Address - Street 2:STE E 180
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2244
Practice Address - Country:US
Practice Address - Phone:865-305-6955
Practice Address - Fax:865-637-5216
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN482363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S06140Medicare UPIN