Provider Demographics
NPI:1194246876
Name:DYER, JENNIFER C (CFNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:DYER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HEALTH WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2668
Mailing Address - Country:US
Mailing Address - Phone:931-473-5394
Mailing Address - Fax:931-473-5865
Practice Address - Street 1:155 HEALTH WAY STE 1
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2668
Practice Address - Country:US
Practice Address - Phone:931-473-5394
Practice Address - Fax:931-473-5865
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN22723OtherNURSE PRACTITIONER WITH CERTFICATE OF FITNESS