Provider Demographics
NPI:1528593126
Name:CARSON, JENNA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 OLD GRAY STATION RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-3869
Mailing Address - Country:US
Mailing Address - Phone:423-291-6896
Mailing Address - Fax:
Practice Address - Street 1:1730 OLD GRAY STATION RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-3869
Practice Address - Country:US
Practice Address - Phone:423-226-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20935363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily