Provider Demographics
NPI:1467076158
Name:WIRSHELS, JON (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:WIRSHELS
Suffix:
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 MONTEZUMA RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4247
Mailing Address - Country:US
Mailing Address - Phone:423-297-2696
Mailing Address - Fax:
Practice Address - Street 1:608 MONTEZUMA RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4247
Practice Address - Country:US
Practice Address - Phone:423-297-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN193226163W00000X
VA0024180462363LF0000X
TN27892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse