Individual
JESSICA DAWN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
1 MEDICAL PARK BLVD, BRISTOL, TN 37620-7430
(423) 844-1121
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
194136
TN
363L00000X
Nurse Practitioner
Primary
27703
TN
363LP0200X
Pediatric Nurse Practitioner
194136
TN
Other
Enumeration date
06/09/2020
Last updated
06/14/2021
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