Provider Demographics
NPI:1497120083
Name:LO, JENNIFER FAVERTY (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FAVERTY
Last Name:LO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7551 DANNAHER DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-4029
Mailing Address - Country:US
Mailing Address - Phone:865-859-7020
Mailing Address - Fax:865-859-7306
Practice Address - Street 1:7551 DANNAHER DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4029
Practice Address - Country:US
Practice Address - Phone:865-859-7020
Practice Address - Fax:865-859-7306
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN19860363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner