Provider Demographics
NPI:1164308532
Name:OBRYAN, JESSIE ERYN
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:ERYN
Last Name:OBRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 HOBBS DR
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-7902
Mailing Address - Country:US
Mailing Address - Phone:615-428-9300
Mailing Address - Fax:
Practice Address - Street 1:409 HOBBS DR
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-7902
Practice Address - Country:US
Practice Address - Phone:188-362-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist