Provider Demographics
NPI:1609141910
Name:ALONSO-JECKELL, YAIMA (MD)
Entity Type:Individual
Prefix:
First Name:YAIMA
Middle Name:
Last Name:ALONSO-JECKELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 DUKE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2709
Mailing Address - Country:US
Mailing Address - Phone:844-291-4535
Mailing Address - Fax:
Practice Address - Street 1:405 DUKE DR
Practice Address - Street 2:STE 210
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2706
Practice Address - Country:US
Practice Address - Phone:844-291-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN528272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME122611OtherME122611
CODR.0057689OtherDR.0057689
CA144674Other144674
TXR0528OtherR0528
TN52827OtherMEDICAL LICENSE NUMBER