Provider Demographics
NPI:1982729984
Name:JOBE, EDNA IMOGENE (RN)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:IMOGENE
Last Name:JOBE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:JOBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:610 KEY SENTER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9171
Mailing Address - Country:US
Mailing Address - Phone:731-427-5964
Mailing Address - Fax:
Practice Address - Street 1:804 N PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3058
Practice Address - Country:US
Practice Address - Phone:731-423-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000027981163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health