Provider Demographics
NPI:1457390882
Name:KLINE, JERRY L (FNP)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:KLINE
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 1:950 BAKER HWY
Mailing Address - Street 2:STE. 4
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37756-4168
Mailing Address - Country:US
Mailing Address - Phone:423-663-4200
Mailing Address - Fax:423-663-4256
Practice Address - Street 1:950 BAKER HWY
Practice Address - Street 2:STE. 4
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756-4168
Practice Address - Country:US
Practice Address - Phone:423-663-4200
Practice Address - Fax:423-663-4256
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717835Medicare ID - Type UnspecifiedGROUP PROVIDER #
TN3900508Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
TNS80658Medicare UPIN