Provider Demographics
NPI:1457383671
Name:STEWART-GLENN, JENNIFER D (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:STEWART-GLENN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 STOUT DRIVE BOX 70403
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-439-4515
Mailing Address - Fax:423-439-4060
Practice Address - Street 1:2700 MAIN ST
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3041
Practice Address - Country:US
Practice Address - Phone:423-439-4515
Practice Address - Fax:423-439-4060
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN008471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN01M2OtherJOHN DEERE
TN100047078OtherPHP
TN3649084Medicaid
TN4091215OtherBLUECROSSBLUESHIELD
TNTN01M2OtherJOHN DEERE
TN3649084Medicare PIN