Provider Demographics
NPI:1215365226
Name:OPLUSTIL, JENI (PA-C)
Entity type:Individual
Prefix:
First Name:JENI
Middle Name:
Last Name:OPLUSTIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CORBAN WAY
Mailing Address - Street 2:
Mailing Address - City:LYLES
Mailing Address - State:TN
Mailing Address - Zip Code:37098-2070
Mailing Address - Country:US
Mailing Address - Phone:770-853-9933
Mailing Address - Fax:
Practice Address - Street 1:4726 TRADERS WAY
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-5366
Practice Address - Country:US
Practice Address - Phone:615-550-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000004455363A00000X
IL085.004900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant