Provider Demographics
NPI:1457808115
Name:JEWELL, KERRI NICHOLE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:NICHOLE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 HARRISON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TENNESSEE
Mailing Address - Zip Code:37110
Mailing Address - Country:UM
Mailing Address - Phone:615-904-5311
Mailing Address - Fax:
Practice Address - Street 1:477 N CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-8901
Practice Address - Country:US
Practice Address - Phone:931-473-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225700000X
TN1589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist