Provider Demographics
NPI:1730484684
Name:TENNANT, JEAN (PA)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:
Last Name:TENNANT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2391
Mailing Address - Country:US
Mailing Address - Phone:931-685-2022
Mailing Address - Fax:931-685-4158
Practice Address - Street 1:1612 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2391
Practice Address - Country:US
Practice Address - Phone:931-685-2022
Practice Address - Fax:931-685-4158
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN581363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical