Provider Demographics
NPI:1568557726
Name:GASTLEY, JENNIFER ADAMS (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ADAMS
Last Name:GASTLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1906
Mailing Address - Country:US
Mailing Address - Phone:706-282-4507
Mailing Address - Fax:706-282-4511
Practice Address - Street 1:222 N BOULEVARD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-1906
Practice Address - Country:US
Practice Address - Phone:706-282-4507
Practice Address - Fax:706-282-4511
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN161832163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse