Provider Demographics
NPI:1760587786
Name:SHOLTZ, JESSICA H (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:H
Last Name:SHOLTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 ALCOA HWY STE 360
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1509
Mailing Address - Country:US
Mailing Address - Phone:865-524-1869
Mailing Address - Fax:865-544-6533
Practice Address - Street 1:1932 ALCOA HWY STE 360
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1509
Practice Address - Country:US
Practice Address - Phone:865-524-1869
Practice Address - Fax:865-544-6533
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012297363LF0000X
TN125090207P00000X
WAAP6028994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDG8914566Medicare PIN
IDN43533OtherARNP