MEDICARE: GERIATRIX CONSULTING LLC

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	363L00000X	Nurse Practitioner	APN10671	TN
2	310400000X	Assisted Living Facility		TN
3	314000000X	Skilled Nursing Facility		TN
4	315D00000X	Inpatient Hospice		TN
5	313M00000X	Nursing Facility/Intermediate Care Facility		TN

General Provider Information

NPI Number	:	1336309806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIX CONSULTING LLC

Provider Business Mailing Address
First Line	:	PO BOX 1184
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37088-1184
Country	:	US
Telephone Number	:	615-686-7773
Fax Number	:

Provider Business Practice Location Address
First Line	:	1483 N MOUNT JULIET RD
Second Line	:	#220
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3315
Country	:	US
Telephone Number	:	615-773-7775
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KRISTY ANNE ROACH
Credential	:	N.P.
Telephone Number	:	615-686-7773

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	12/10/2014

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