Provider Demographics
NPI:1619689981
Name:CPESN TENNESSEE
Entity type:Organization
Organization Name:CPESN TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING NETWORK FACILITATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-817-0355
Mailing Address - Street 1:1000 MONARCH PT
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 MONARCH PT
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4656
Practice Address - Country:US
Practice Address - Phone:423-817-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare