Doctor Name: | JAMIE B MONGER |
NPI Number: | 1043649031 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 18134 |
Business Practice Address: | 250 Bmh Physicians Office Bldg Maryville, TN - 378045904 |
Business Phone Number: | 8659805200 |
Business Fax Number: | 8659805201 |
Mailing Address: | 250 Bmh Physicians Office Bldg, MARYVILLE |
State: | TN |
Postal Code: | 378045904 |
Phone Number: | 8659805200 |
Fax Number: | 8659805201 |
NPI Enumeration Date: | 11/11/2013 |
NPI Last Update Date: | 03/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 18134 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |