Provider Demographics
NPI:1336281609
Name:WEBER, JENNIFER WALKER
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:WALKER
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:D
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 RICHARD JONES RD.
Mailing Address - Street 2:STE. 220
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215
Mailing Address - Country:US
Mailing Address - Phone:615-383-2400
Mailing Address - Fax:615-383-1948
Practice Address - Street 1:1756 POPPS FERRY RD STE A
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2118
Practice Address - Country:US
Practice Address - Phone:228-865-3200
Practice Address - Fax:228-575-1600
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN10802363LF0000X
MS889212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3648434Medicaid
Q39500Medicare UPIN
3648434Medicare PIN