Provider Demographics
NPI:1285841296
Name:HARPER, JACKIE L (NP)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:L
Last Name:HARPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PATTERSON ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-515-1900
Mailing Address - Fax:615-515-1993
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:SUITE 502
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-515-1900
Practice Address - Fax:615-515-1993
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN06589363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341325Medicaid
TN3341325Medicare PIN
P00423289Medicare PIN