Doctor Name: | JAQUETTA J WOLF-KING |
NPI Number: | 1699179135 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | 18974 |
Business Practice Address: | 491 Sage Rd N White House, TN - 371889360 |
Business Phone Number: | 6155810091 |
Business Fax Number: | |
Mailing Address: | 491 Sage Rd N, WHITE HOUSE |
State: | TN |
Postal Code: | 371889360 |
Phone Number: | 6155810091 |
Fax Number: | |
NPI Enumeration Date: | 10/13/2014 |
NPI Last Update Date: | 05/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 18974 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |