Provider Demographics
NPI:1770794711
Name:HANEY, JENNIE R (CPNP)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:R
Last Name:HANEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EAST TOWN CREEK RD.
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772
Mailing Address - Country:US
Mailing Address - Phone:865-986-1400
Mailing Address - Fax:865-986-9400
Practice Address - Street 1:125 EAST TOWN CREEK RD.
Practice Address - Street 2:SUITE 2B
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772
Practice Address - Country:US
Practice Address - Phone:865-986-1400
Practice Address - Fax:865-986-9400
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007928363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics