Individual provider Active NPI

Jacqueline Marie Windham, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Knoxville, TN
National Provider Identifier
1104394279
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
36405 Issued in TN
Practice address
1451 Dowell Springs Blvd
Knoxville, TN 37909-2441
Phone
(865) 970-9800
NPI assigned
Nov 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 36405 TN Primary

Addresses

Primary practice location

1451 Dowell Springs Blvd
Knoxville, TN 37909-2441

Mailing address

1451 Dowell Springs Blvd
Knoxville, TN 37909-2441
Phone (865) 970-9800

Other practice location 1

10 Gove St
East Boston, MA 02128-1920
Phone (617) 569-5800 ext. 4872

Other practice location 2

1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723
Phone (415) 658-6791

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250131000004 TN Practitioner - Nurse Practitioner 9739424458

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: jacqueline.windham.1@31900.direct.athenahealth.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753920000000",
    "number": "1104394279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 DOWELL SPRINGS BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092441",
            "telephone_number": "865-970-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 DOWELL SPRINGS BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092441",
            "telephone_number": "865-970-9800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Gove St",
            "address_purpose": "LOCATION",
            "city": "East Boston",
            "state": "MA",
            "postal_code": "021281920",
            "country_code": "US",
            "telephone_number": "617-569-5800 x4872",
            "fax_number": "617-568-4756",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Embarcadero Ctr Ste 1900",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941113723",
            "country_code": "US",
            "telephone_number": "415-658-6791",
            "fax_number": "415-252-7176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WINDHAM",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-07",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "36405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.