Provider Demographics
NPI:1720238462
Name:BINGHAM, JAIME C (APN)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:C
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:C
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:5000 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4054
Mailing Address - Country:US
Mailing Address - Phone:423-870-1662
Mailing Address - Fax:423-877-4845
Practice Address - Street 1:5000 ALPHA LN
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4054
Practice Address - Country:US
Practice Address - Phone:423-870-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN200398363LF0000X
TNAPN0000013498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily