Provider Demographics
NPI:1316245137
Name:BARHAM, JENNIFER MICHELLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:BARHAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 APPLEBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-3389
Mailing Address - Country:US
Mailing Address - Phone:423-502-2134
Mailing Address - Fax:
Practice Address - Street 1:300 E 56TH ST APT 3C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4135
Practice Address - Country:US
Practice Address - Phone:516-210-5600
Practice Address - Fax:917-254-4419
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15635363LF0000X
TN7770247207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily