Provider Demographics
NPI:1942867361
Name:TYNER, JESSICA BURNS (RN, SRNA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BURNS
Last Name:TYNER
Suffix:
Gender:F
Credentials:RN, SRNA
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:BURNS
Other - Last Name:TYNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1175 PINEVILLE RD APT 174
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-2698
Mailing Address - Country:US
Mailing Address - Phone:828-446-4259
Mailing Address - Fax:
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-602-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN193430163W00000X
TXAP143319367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse