Individual
JESSICA SUZANNE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1404 TUSCULUM BLVD STE 2200, GREENEVILLE, TN 37745-4395
(423) 783-5520
(423) 390-6985
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 952-2111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2195
TN
363AM0700X
Medical Physician Assistant
Primary
2195
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4344229
BCBS OF TN
TN
01
—
P01160560
RR MEDICARE
TN
05
—
Q000136
—
TN
Enumeration date
10/08/2012
Last updated
12/31/2025
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