Beverly J Jacks
Nurse Practitioner - Women's Health
6116 Shallowford Rd Suite 117
Chattanooga
, Tennessee 37421-7201
Beverly J Jacks
Nurse Practitioner - Women's Health
6116 Shallowford Rd Suite 117
Chattanooga
, Tennessee 37421-7201
(423) 702-5605
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About
Features
Specialties
- Nurse Practitioner - Women's Health
Languages spoken
- English
Location
First Address
- Beverly J Jacks
- 6116 Shallowford Rd Suite 117
- Chattanooga, TN
- Zip : 37421-7201
- Fax : (423) 702-5605
- Phone : (423) 702-5581
Second Address
- Beverly J Jacks
- 6116 Shallowford Rd Suite 117
- Chattanooga, TN
- Zip : 37421-7201
- Fax : (423) 702-5605
- Phone : (423) 702-5581
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LW0102X | Nurse Practitioner - Women's Health | 5511 | TN |
National Provider Identifier
| NPI | 1003954595 |
|---|---|
| Provider Name | Beverly J Jacks |
| First Address | Chattanooga, TN 37421-7201 |
| Second Address | Chattanooga, TN 37421-7201 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 05/02/2007 |
| Last Update Date | 04/12/2012 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 3495196 | (02) | TN |
| 3495196 | (05) | TN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.