Provider Demographics
NPI:1447282611
Name:CHEEKS, JIMMY WAYNE JR (NP)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:WAYNE
Last Name:CHEEKS
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:754 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3323
Practice Address - Country:US
Practice Address - Phone:615-754-2828
Practice Address - Fax:651-754-2818
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4083915OtherBLUECROSS BLUESHIELD
TN3347576Medicare ID - Type Unspecified
TNP55165Medicare UPIN