Provider Demographics
NPI:1821650474
Name:GULCH, JESSICA (APRN, NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GULCH
Suffix:
Gender:F
Credentials:APRN, NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5906 MAIN ST STE 132
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9297
Mailing Address - Country:US
Mailing Address - Phone:423-468-1226
Mailing Address - Fax:
Practice Address - Street 1:5906 MAIN ST STE 132
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-9297
Practice Address - Country:US
Practice Address - Phone:423-468-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012727A363LF0000X, 363LG0600X
VA0024177824363LA2100X
TN31312363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology