Provider Demographics
NPI:1124623665
Name:RICHMOND, JESSIE DANIELLE (APRN)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:DANIELLE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 STRATUS DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-7907
Mailing Address - Country:US
Mailing Address - Phone:931-638-2453
Mailing Address - Fax:
Practice Address - Street 1:1118 STRATUS DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-7907
Practice Address - Country:US
Practice Address - Phone:931-638-2453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000028626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily