Provider Demographics
NPI:1669761680
Name:WEBSTER, JENNIFER P (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:P
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LAUREN
Other - Last Name:PRESCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11416 GRIGSBY CHAPEL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1649
Mailing Address - Country:US
Mailing Address - Phone:865-524-2547
Mailing Address - Fax:865-205-5601
Practice Address - Street 1:11416 GRIGSBY CHAPEL RD STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1649
Practice Address - Country:US
Practice Address - Phone:865-675-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105939363AS0400X
TN3617363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ038444Medicaid