Provider Demographics
NPI:1235642000
Name:STEVENS, JENIFER JILL (APRN)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:JILL
Last Name:STEVENS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2521
Mailing Address - Country:US
Mailing Address - Phone:931-528-5811
Mailing Address - Fax:931-526-1497
Practice Address - Street 1:105 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2521
Practice Address - Country:US
Practice Address - Phone:931-528-5811
Practice Address - Fax:931-526-1497
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily