Provider Demographics
NPI:1053903740
Name:SHEHAN, JESSICA ANNETTE (APN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNETTE
Last Name:SHEHAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 E BROADWAY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4949
Mailing Address - Country:US
Mailing Address - Phone:865-475-9062
Mailing Address - Fax:
Practice Address - Street 1:657 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4948
Practice Address - Country:US
Practice Address - Phone:865-475-9062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1155465163W00000X
TNAPN35356363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse