Provider Demographics
NPI:1881850410
Name:MCNEELY, JAMIE S (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:S
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:SINGLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:317 SEVEN SPRINGS WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4576
Mailing Address - Country:US
Mailing Address - Phone:615-370-9992
Mailing Address - Fax:615-370-9665
Practice Address - Street 1:317 SEVEN SPRINGS WAY STE 101
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4576
Practice Address - Country:US
Practice Address - Phone:615-370-9992
Practice Address - Fax:615-370-9665
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001688363A00000X
TN3145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ056617Medicaid
VA092800OtherANTHEM BC
VA010033594Medicaid