Provider Demographics
NPI:1053148429
Name:JESSOP, BRILEE DIANE
Entity type:Individual
Prefix:
First Name:BRILEE
Middle Name:DIANE
Last Name:JESSOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 S STONECROP CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1495
Mailing Address - Country:US
Mailing Address - Phone:520-647-1284
Mailing Address - Fax:
Practice Address - Street 1:326 S STONECROP CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1495
Practice Address - Country:US
Practice Address - Phone:520-647-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF09240625363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner