Individual
JAMIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Contact information
Practice address
365 STOUT DRIVE, SUITE 160, JOHNSON CITY, TN 37614-1703
(423) 439-4225
(423) 439-4560
Mailing address
365 STOUT DRIVE, BOX 70403, JOHNSON CITY, TN 37614-1703
(423) 439-4515
(423) 439-5780
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21637
TN
363LP2300X
Primary Care Nurse Practitioner
21637
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21637
LICENSE
TN
Enumeration date
10/31/2016
Last updated
06/30/2017
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