Individual
MS. JEAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
919 E CENTRAL AVE, SCOTT COUNTY HOSPITAL, LA FOLLETTE, TN 37766-2777
(423) 907-1553
(865) 777-0910
Mailing address
675 COX HOLLOW RD, KINGSPORT, TN 37663-3150
(423) 349-4314
(423) 349-0349
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN0000033906
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3608552
—
TN
Enumeration date
08/31/2006
Last updated
07/01/2009
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