Provider Demographics
NPI:1174924765
Name:BEST, JIMMIE JR
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:
Last Name:BEST
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 DEEP CUT RD
Mailing Address - Street 2:
Mailing Address - City:ERIN
Mailing Address - State:TN
Mailing Address - Zip Code:37061-6843
Mailing Address - Country:US
Mailing Address - Phone:870-416-0787
Mailing Address - Fax:
Practice Address - Street 1:1411 DEEP CUT RD
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061-6843
Practice Address - Country:US
Practice Address - Phone:870-416-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR084738163WP0807X
TNRN179287163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent