Provider Demographics
NPI:1487844858
Name:SEABORN, JEREMY BRIAN (NP)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:BRIAN
Last Name:SEABORN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-4110
Mailing Address - Country:US
Mailing Address - Phone:615-444-2121
Mailing Address - Fax:615-547-6474
Practice Address - Street 1:702 S CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-4110
Practice Address - Country:US
Practice Address - Phone:615-444-2121
Practice Address - Fax:615-547-6474
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3323094OtherUHC
TN7386616OtherCIGNA
TN12242559OtherCAQH
TNRN140019OtherRN LICENSE
TNAPN8415OtherAPN LICENCE
TN4297216OtherBCBS
TN4297216OtherBCBS