Organization
JELLICO WELLNESS AND CONVENIENT CARE CLINIC, LLC
Active
Other names
Jellico Wellness Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE ASANTE FAMILY NURSE PRACTIT (FNP/PRESIDENT)
(615) 335-3430
Entity
Organization
Contact information
Practice address
1811 5TH ST, JELLICO, TN 37762-4629
(615) 335-3430
Mailing address
1811 5TH ST, JELLICO, TN 37762-4629
(423) 455-3032
(423) 455-3042
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
14174
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1031508098
MEDICARE
TN
05
—
1527342
—
TN
Enumeration date
03/21/2018
Last updated
09/05/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us