Individual
BEVERLY J JACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM, APRN
Contact information
Practice address
6116 SHALLOWFORD RD, SUITE 117, CHATTANOOGA, TN 37421-7201
(423) 702-5581
(423) 702-5605
Mailing address
6116 SHALLOWFORD RD, SUITE 117, CHATTANOOGA, TN 37421-7201
(423) 702-5581
(423) 702-5605
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
5511
TN
367A00000X
Advanced Practice Midwife
05511
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3495196
—
TN
Enumeration date
02/05/2007
Last updated
12/04/2012
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