Church, Jackie A
Church, Jackie A is an individual health care provider with primary practice located at 4600 Fort Henry Dr , Kingsport TN 37663-2617. She recently has 3 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Church, Jackie A can be contacted via phone (423) 224-3950.Contact Information
Primary practice address
4600 Fort Henry Dr
Kingsport TN 37663-2617
Phone: (423) 224-3950
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Providers / Registered Nurse | 163W00000X | 143764 | Tennessee |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 0024187900 | Virginia |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 5018685 | North Carolina |
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | APN12537 | Tennessee |
Profile Details
| NPI number | 1629126321 |
|---|---|
| LBN Legal business name | Church, Jackie A |
| Credentials | Advanced Practice Nurse (APN) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 8th, 2007 |
| Last updated | Oct 18th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629126321 | NPPES |
| Tennessee | Other | P01171831 | RR MEDICARE |
| Tennessee | MEDICAID | 1629126321 | RR MEDICARE |
| Tennessee | MEDICAID | 1629126321 | RR MEDICARE |
| Tennessee | MEDICAID | 3341016 | RR MEDICARE |
| Tennessee | MEDICAID | 7100236150 | RR MEDICARE |
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