Jacks, Beverly J

Jacks, Beverly J is an sole proprietor health care provider with primary practice located at 6116 Shallowford Rd Suite 117, Chattanooga TN 37421-7201. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, Physician Assistants & Advanced Practice Nursing Providers / Women's Health. Physician Assistants & Advanced Practice Nursing Providers / Women's Health is her primary health care specialty. Jacks, Beverly J can be contacted via phone (423) 702-5581.

Contact Information

Primary practice address
6116 Shallowford Rd Suite 117 Chattanooga TN 37421-7201
Phone: (423) 702-5581
Fax: (423) 702-5605
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 05511 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Women's Health 363LW0102X 5511 Tennessee

Profile Details

NPI number 1003954595
LBN Legal business name Jacks, Beverly J
Credentials CNM, APRN
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 5th, 2007
Last updated Dec 4th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003954595 NPPES
Tennessee MEDICAID 3495196

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