Provider Demographics
NPI:1619223344
Name:LEVI, JEANNIE B (APN)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:B
Last Name:LEVI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3755
Mailing Address - Country:US
Mailing Address - Phone:423-623-6240
Mailing Address - Fax:423-623-0102
Practice Address - Street 1:407 4TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3755
Practice Address - Country:US
Practice Address - Phone:423-623-6240
Practice Address - Fax:423-623-0102
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN16750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530099Medicaid
TN1530099Medicaid