Provider Demographics
NPI:1679163539
Name:MINOR, JENNIFER VALLIE JEANNE (APRN, ACNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:VALLIE JEANNE
Last Name:MINOR
Suffix:
Gender:F
Credentials:APRN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MINOR RD
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37022-9185
Mailing Address - Country:US
Mailing Address - Phone:615-388-7720
Mailing Address - Fax:615-888-3225
Practice Address - Street 1:355 NEW SHACKLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2479
Practice Address - Country:US
Practice Address - Phone:615-388-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000150949163WE0003X
TN33409363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency