MEDICARE: MR. EDWIN SIMON NP

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	APN6734	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609806256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWIN SIMON NP

Provider Business Mailing Address
First Line	:	2004 HWY 47 N
Second Line	:
City	:	WHITE BLUFF
State	:	TN
Zip	:	37187-4100
Country	:	US
Telephone Number	:	615-797-3646
Fax Number	:	615-797-4055

Provider Business Practice Location Address
First Line	:	2004 HWY 47 N
Second Line	:
City	:	WHITE BLUFF
State	:	TN
Zip	:	37187-4100
Country	:	US
Telephone Number	:	615-797-3646
Fax Number	:	615-797-4055

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	01/21/2011

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