Provider Demographics
NPI:1306112354
Name:JEANS, NAISHIA P (APN)
Entity type:Individual
Prefix:
First Name:NAISHIA
Middle Name:P
Last Name:JEANS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:NAISHIA
Other - Middle Name:
Other - Last Name:PERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1444 E SHELBY DR STE 317
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7257
Mailing Address - Country:US
Mailing Address - Phone:901-396-8366
Mailing Address - Fax:901-396-1421
Practice Address - Street 1:1444 E SHELBY DR STE 317
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7257
Practice Address - Country:US
Practice Address - Phone:901-396-8366
Practice Address - Fax:901-396-1421
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527299Medicaid