Active NPI
Beverly J Jacks, CNM, APRN
- Women's Health Nurse Practitioner
- Chattanooga, TN
National Provider Identifier
1003954595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- 5511
- Practice address
- 6116 Shallowford Rd
Suite 117
Chattanooga, TN 37421-7201 - Phone
- (423) 702-5581
- Fax
- (423) 702-5605
- NPI assigned
- Feb 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 05511 | TN | |
| Women's Health Nurse Practitioner | 363LW0102X | 5511 | TN | Primary |
Addresses
Primary practice location
6116 Shallowford Rd
Suite 117
Chattanooga, TN 37421-7201
Mailing address
6116 Shallowford Rd
Suite 117
Chattanooga, TN 37421-7201
Phone (423) 702-5581
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3495196 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5511 | TN | MD | Physical Therapist |
| 05511 | TN | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Galen Medical Group, PC | Women's Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354579200000",
"number": "1003954595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6116 SHALLOWFORD RD",
"address_2": "SUITE 117",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374217201",
"telephone_number": "423-702-5581",
"fax_number": "423-702-5605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6116 SHALLOWFORD RD",
"address_2": "SUITE 117",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374217201",
"telephone_number": "423-702-5581",
"fax_number": "423-702-5605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKS",
"first_name": "BEVERLY",
"middle_name": "J",
"credential": "CNM, APRN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-05",
"last_updated": "2012-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "TN",
"license": "05511",
"primary": false
},
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "TN",
"license": "5511",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3495196",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.