Provider Demographics
NPI:1821575473
Name:PARISH, JACLYN S (APN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:S
Last Name:PARISH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:S
Other - Last Name:CHITTUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:320 PARK 40 NORTH BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3624
Mailing Address - Country:US
Mailing Address - Phone:865-692-3462
Mailing Address - Fax:865-670-6333
Practice Address - Street 1:320 N PARK 40 BLVD STE A
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3624
Practice Address - Country:US
Practice Address - Phone:865-692-3462
Practice Address - Fax:865-692-3463
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner