| Ultra Health Providers Ii Llc | |
|
36 Pemberton Cv Jackson TN 38305-5514 | |
| (731) 394-1145 | |
| Not Available |
| Full Name | Ultra Health Providers Ii Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 36 Pemberton Cv, Jackson, Tennessee |
| Authorized Official Name and Position | Charles Richard Jerman (MEMBER) |
| Authorized Official Contact | 7312348120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ultra Health Providers Ii Llc 36 Pemberton Cv Jackson TN 38305-5514 Ph: (731) 394-1145 | Ultra Health Providers Ii Llc 36 Pemberton Cv Jackson TN 38305-5514 Ph: (731) 394-1145 |
| NPI Number | 1033956057 |
|---|---|
| Provider Enumeration Date | 07/09/2024 |
| Last Update Date | 07/09/2024 |
| Medicare PECOS PAC ID | 5395284616 |
|---|---|
| Medicare Enrollment ID | O20240829003110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033956057 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Dalton Kristofer Hunter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417690223 PECOS PAC ID: 6709263874 Enrollment ID: I20220510002104 |
| Provider Name | Sheena Makerrin Mceachin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477242634 PECOS PAC ID: 9133585086 Enrollment ID: I20230518001184 |
| Provider Name | Tashamba Lashira Davis-denson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972366730 PECOS PAC ID: 5294179297 Enrollment ID: I20240219000074 |
| Provider Name | Hannah Wooten |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376378661 PECOS PAC ID: 8022543859 Enrollment ID: I20241203001042 |
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