Provider Demographics
NPI:1407899446
Name:MORTON, JENNIFER M (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MORTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5777
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5777
Mailing Address - Country:US
Mailing Address - Phone:865-246-2104
Mailing Address - Fax:865-246-2106
Practice Address - Street 1:250 BMH PHYSICIANS OFFICE BLDG
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5904
Practice Address - Country:US
Practice Address - Phone:865-980-5200
Practice Address - Fax:865-980-5201
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN129007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4029947OtherBLUE CROSS BLUE SHIELD #
TN129007OtherADVANCED PRACTICE NURSE #
TN3909721Medicaid
TNP49876Medicare UPIN
TN3909721Medicare PIN