Individual
JACKIE A CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
344 OVERLOOK DR STE 200, LEBANON, VA 24266-3436
(276) 883-5900
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 952-2111
(423) 282-1657
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
143764
TN
363LF0000X
Family Nurse Practitioner
0024187900
VA
363LF0000X
Family Nurse Practitioner
5018685
NC
363LF0000X
Family Nurse Practitioner
Primary
APN12537
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629126321
—
NC
05
—
1629126321
—
VA
05
—
3341016
—
TN
05
—
7100236150
—
KY
01
—
P01171831
RR MEDICARE
TN
Enumeration date
01/08/2007
Last updated
10/14/2025
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