Provider Demographics
NPI:1871634428
Name:GIVENS, JAMIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:GIVENS
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-230-2420
Mailing Address - Fax:423-230-2422
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:SUITE 1F
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3256
Practice Address - Country:US
Practice Address - Phone:423-230-2420
Practice Address - Fax:423-230-2422
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1871634428Medicaid
TN1509990Medicaid
TN3341619Medicare UPIN
VAC06181Medicare UPIN
TN3700592Medicare UPIN
TN1509990Medicaid
VA1871634428Medicaid