Individual
JENNIFER RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2202 MARTIN LUTHER KING JR AVE, KNOXVILLE, TN 37915-1570
(865) 522-6097
(865) 540-1615
Mailing address
1923 SULPHUR SPRINGS RD, MORRISTOWN, TN 37813-5654
(423) 317-9344
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
56989
TN
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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