Provider Demographics
NPI:1790052165
Name:HAZARD, JAMIE NEKOLE (NP-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:NEKOLE
Last Name:HAZARD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 PLEASANT RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37345-5934
Mailing Address - Country:US
Mailing Address - Phone:931-308-7067
Mailing Address - Fax:
Practice Address - Street 1:707 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTLAND
Practice Address - State:TN
Practice Address - Zip Code:37345-3263
Practice Address - Country:US
Practice Address - Phone:931-469-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528097Medicaid
TN1528097Medicaid