Doctor Name: | MRS. JACQUELINE LEE SWALLOWS |
NPI Number: | 1023397957 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC, NP-C |
License Number: | 16020 |
Business Practice Address: | 319 Broad St Baxter, TN - 385445117 |
Business Phone Number: | 9318582116 |
Business Fax Number: | 9318582117 |
Mailing Address: | 319 Broad St, BAXTER |
State: | TN |
Postal Code: | 385445117 |
Phone Number: | 9318582116 |
Fax Number: | 9318582117 |
NPI Enumeration Date: | 08/09/2011 |
NPI Last Update Date: | 07/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 16020 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |