MEDICARE: DR. SAMANTHA ELIZABETH PERSON-ALDRIDGE DNP, PMHNP-BC,FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	183218	TN
2	363LF0000X	Family Nurse Practitioner	22983	TN
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	22983	TN

General Provider Information

NPI Number	:	1003331208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA ELIZABETH PERSON-ALDRIDGE DNP, PMHNP-BC,FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 363
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-0363
Country	:	US
Telephone Number	:	901-403-0901
Fax Number	:

Provider Business Practice Location Address
First Line	:	3173 KIRBY WHITTEN RD STE 104
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-2881
Country	:	US
Telephone Number	:	901-384-8040
Fax Number	:	901-888-4748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	06/05/2022

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