Individual
JACQUELINE GROOMS OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP-AC
Contact information
Practice address
329 WESLEY ST, JOHNSON CITY, TN 37601-1772
(423) 631-0055
Mailing address
329 WESLEY ST, JOHNSON CITY, TN 37601-1772
(423) 631-0055
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
32794
TN
363LP0200X
Pediatric Nurse Practitioner
5008262
NC
Other
Enumeration date
12/21/2015
Last updated
05/20/2024
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