Provider Demographics
NPI:1093885337
Name:EISENHOWER, JENNIFER S (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:S
Last Name:EISENHOWER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3755
Mailing Address - Country:US
Mailing Address - Phone:423-623-6240
Mailing Address - Fax:423-623-0102
Practice Address - Street 1:1403 STATE ST
Practice Address - Street 2:
Practice Address - City:WHITE PINE
Practice Address - State:TN
Practice Address - Zip Code:37890-3175
Practice Address - Country:US
Practice Address - Phone:865-674-6603
Practice Address - Fax:865-674-6695
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3928109Medicaid
TN3928109Medicaid
TN103I507290Medicare PIN