Provider Demographics
NPI:1376979583
Name:CUNNINGHAM, JACY TAYLOR (APN)
Entity Type:Individual
Prefix:
First Name:JACY
Middle Name:TAYLOR
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WILLIAMS CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-5301
Mailing Address - Country:US
Mailing Address - Phone:615-319-5042
Mailing Address - Fax:
Practice Address - Street 1:783 OLD HICKORY BLVD STE 355
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4986
Practice Address - Country:US
Practice Address - Phone:615-340-5544
Practice Address - Fax:615-327-1009
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 17917363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health