| NPI | 1164943957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN PORTER Credentialing Manager 615-630-0988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2023-07-10 |