Provider Demographics
NPI:1063804532
Name:PASSMORE, JAY ANTHONY (MSN)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:ANTHONY
Last Name:PASSMORE
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2305 CHAMBLISS AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3847
Mailing Address - Country:US
Mailing Address - Phone:423-559-6000
Mailing Address - Fax:
Practice Address - Street 1:1635 GUNBARREL RD STE 400
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4987
Practice Address - Country:US
Practice Address - Phone:423-778-5693
Practice Address - Fax:423-778-8543
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN132749163WF0300X
TN19928363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WF0300XNursing Service ProvidersRegistered NurseFlight