MEDICARE: HAILEY DIANA BURTON FNP-C

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	30844	TN

General Provider Information

NPI Number	:	1629726708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY DIANA BURTON FNP-C

Provider Business Mailing Address
First Line	:	18206 BARTONS RUN TRCE
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37090-2557
Country	:	US
Telephone Number	:	615-428-0964
Fax Number	:

Provider Business Practice Location Address
First Line	:	13181 OLD NASHVILLE HWY STE 150
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-4034
Country	:	US
Telephone Number	:	615-355-5105
Fax Number	:

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

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	04/12/2023

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