Provider Demographics
NPI:1578197836
Name:PRATT, JESSICA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:512 MARBURY RD
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2142
Mailing Address - Country:US
Mailing Address - Phone:931-581-0115
Mailing Address - Fax:
Practice Address - Street 1:1400 WILLOW DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2438
Practice Address - Country:US
Practice Address - Phone:931-409-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27252363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care