Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 25928 | TN |
NPI | 1003474354 |
---|---|
Provider Name | Mrs. Jessica Lynn Hamby |
First Address | Rockwood, TN 37854-3549 |
Second Address | Oak Ridge, TN 37830-6474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2019 |
Last Update Date | 18/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212152 | RN LICENSE (01) | TN |
Q051436 | (05) | TN |