Provider Demographics
NPI:1528196672
Name:WALDROP, JESSICA NICOLE (BS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:WALDROP
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VALLEY VIEW DR APT 33
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2820
Mailing Address - Country:US
Mailing Address - Phone:865-250-8248
Mailing Address - Fax:
Practice Address - Street 1:105 WAVERLY PLZ
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1531
Practice Address - Country:US
Practice Address - Phone:931-296-4356
Practice Address - Fax:931-296-4529
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator