Provider Demographics
NPI:1831663905
Name:WYRICK, JENNIFER (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WYRICK
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2946 WINFIELD DUNN PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-4316
Mailing Address - Country:US
Mailing Address - Phone:865-933-9950
Mailing Address - Fax:865-465-3937
Practice Address - Street 1:2946 WINFIELD DUNN PKWY STE 107
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-4316
Practice Address - Country:US
Practice Address - Phone:865-933-9950
Practice Address - Fax:865-465-3937
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000025227363LP2300X
TN25227363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty