Provider Demographics
NPI:1790052165
Name:HAZARD, JAMIE NEKOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NEKOLE
Last Name:HAZARD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 OLD COWAN RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-1913
Mailing Address - Country:US
Mailing Address - Phone:931-962-1004
Mailing Address - Fax:931-962-1400
Practice Address - Street 1:1750 CEDAR LN
Practice Address - Street 2:SUITE 200
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4759
Practice Address - Country:US
Practice Address - Phone:931-393-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528097Medicaid
TN1528097Medicaid