Provider Demographics
NPI:1972115921
Name:PHIPPS, JESSICA RENEA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RENEA
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 VOLUNTEER PKWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-5700
Mailing Address - Country:US
Mailing Address - Phone:423-274-0259
Mailing Address - Fax:
Practice Address - Street 1:1388 VOLUNTEER PKWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-5700
Practice Address - Country:US
Practice Address - Phone:423-274-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist