Provider Demographics
NPI:1437245792
Name:COLSTON, JAMEY K (FNP)
Entity Type:Individual
Prefix:
First Name:JAMEY
Middle Name:K
Last Name:COLSTON
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 399
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-0399
Mailing Address - Country:US
Mailing Address - Phone:901-466-0250
Mailing Address - Fax:901-466-0258
Practice Address - Street 1:12995 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-6115
Practice Address - Country:US
Practice Address - Phone:901-465-0250
Practice Address - Fax:901-465-0738
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000005859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4264387OtherBLUE CROSS
TN3022250Medicaid
TN9656279OtherCIGNA COMMERCIAL
TNPE-59634OtherPECOS
TN3644575Medicaid
TN4108029OtherBLUE CROSS GROUP
TN4264387OtherBLUE CROSS
TN3644575Medicare PIN
TN4108029OtherBLUE CROSS GROUP