Provider Demographics
NPI:1184169658
Name:JARRETT, WANDA (NP)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:JARRETT
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 1:115 JUDGE GRESHAM RD STE B
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6213
Mailing Address - Country:US
Mailing Address - Phone:423-477-2010
Mailing Address - Fax:423-477-2161
Practice Address - Street 1:115 JUDGE GRESHAM RD STE B
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-6213
Practice Address - Country:US
Practice Address - Phone:423-477-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21429363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN21429OtherLICENSE
TN3714470OtherGROUP MEDICARE