Provider Demographics
NPI:1265606107
Name:PICKWELL, JENNIFER M (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:PICKWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E HILL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37915-2565
Mailing Address - Country:US
Mailing Address - Phone:865-862-0998
Mailing Address - Fax:865-544-1861
Practice Address - Street 1:9957 SHERRILL BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3366
Practice Address - Country:US
Practice Address - Phone:656-932-2558
Practice Address - Fax:865-691-7888
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12226363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00614347OtherMEDICARE RR
TN1505261Medicaid
TN4213763OtherBLUE CROSS BLUE SHIELD
TN3341837Medicare PIN