Provider Demographics
NPI:1285300194
Name:WILD, JESSICA SPERRY (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SPERRY
Last Name:WILD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 VICTORIAN PARK CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-0900
Mailing Address - Country:US
Mailing Address - Phone:678-654-9838
Mailing Address - Fax:
Practice Address - Street 1:1800 MEDICAL CENTER PKWY STE 330
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2586
Practice Address - Country:US
Practice Address - Phone:615-410-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN242268163WC0200X
TN35430367500000X
AL1-166645163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty