Jellico Wellness and Convenient Care Clinic, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

JELLICO WELLNESS AND CONVENIENT CARE CLINIC, LLC

Doing business as

Jellico Wellness Behavioral Health

Practice address

1811 5TH St
Jellico, TN 37762-4629

Phone

(615) 335-3430

NPI assigned

Mar 21, 2018

Organization subpart

No

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

Authorized official

Name

Nicole Asante, FAMILY NURSE PRACTIT

Title

FNP/President

Phone

(615) 335-3430

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Jellico Wellness Behavioral Health Doing business as

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17643/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1952805319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 5TH ST",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377624629",
            "telephone_number": "423-455-3032",
            "fax_number": "423-455-3042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 5TH ST",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377624629",
            "telephone_number": "615-335-3430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JELLICO WELLNESS AND CONVENIENT CARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-21",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "ASANTE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "FNP/PRESIDENT",
        "authorized_official_telephone_number": "615-335-3430",
        "authorized_official_credential": "FAMILY NURSE PRACTIT"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TN",
            "license": "14174",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1527342",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1031508098",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jellico Wellness Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Jellico, TN
• Providers in Jellico, TN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.