Individual provider Active NPI

Jennifer A Colvin, ANP

  • Women's Health Nurse Practitioner
  • Knoxville, TN
National Provider Identifier
1710050091
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
8095 Issued in TN
Practice address
501 19TH St.
Suite 401
Knoxville, TN 37916-1839
Phone
(865) 331-2020
Fax
(865) 331-1976
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 8095 TN Primary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 128888 TN

Addresses

Primary practice location

501 19TH St.
Suite 401
Knoxville, TN 37916-1839

Mailing address

501 19TH St.
Suite 401
Knoxville, TN 37916-1839
Phone (865) 331-2020

Other identifiers 1

IdentifierTypeStateIssuer
Q004379MedicaidTN

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
I20220104002372 TN Practitioner - Nurse Practitioner 3678862760 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
128888TNMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Sanders Perinatal Center CurrentSince Jan 1, 2022 Accepting new patients

Locations

501 19th St
Ste 401
Knoxville, TN 37916
Phone (865) 331-2020

Dept 888247
Knoxville, TN 37995

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1710050091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 19TH ST.",
            "address_2": "SUITE 401",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161839",
            "telephone_number": "865-331-2020",
            "fax_number": "865-331-1976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 19TH ST.",
            "address_2": "SUITE 401",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161839",
            "telephone_number": "865-331-2020",
            "fax_number": "865-331-1976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLVIN",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "TN",
            "license": "8095",
            "primary": true
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "TN",
            "license": "128888",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q004379",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.