| Doctor Name: | JENNIE L. WALLS |
| NPI Number: | 1265517197 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | APN5169 |
| Business Practice Address: | David Crockett High School Health Clinic 684 Old State Route 34 Jonesborough, TN - 37659 |
| Business Phone Number: | 4237530057 |
| Business Fax Number: | |
| Mailing Address: | Po Box 70403, JOHNSON CITY |
| State: | TN |
| Postal Code: | 376141703 |
| Phone Number: | 4234394078 |
| Fax Number: | 4234394060 |
| NPI Enumeration Date: | 10/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APN5169 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |