Provider Demographics
NPI:1447146675
Name:WALDEN, JERRICA SIMONE
Entity type:Individual
Prefix:
First Name:JERRICA
Middle Name:SIMONE
Last Name:WALDEN
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 1:2009 23RD AVE N UNIT A
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-1366
Mailing Address - Country:US
Mailing Address - Phone:843-303-1040
Mailing Address - Fax:
Practice Address - Street 1:2009 23RD AVE N UNIT A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-1366
Practice Address - Country:US
Practice Address - Phone:843-303-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program