MEDICARE: LINDA S TREVATHAN RN, NURSE PRACTITION

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	150915	MO
2	363LF0000X	Family Nurse Practitioner	AP129453	TX
3	363LF0000X	Family Nurse Practitioner	21309	TN

General Provider Information

NPI Number	:	1639123201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA S TREVATHAN RN, NURSE PRACTITION

Provider Business Mailing Address
First Line	:	2711 FOSTER AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-5307
Country	:	US
Telephone Number	:	615-227-3000
Fax Number	:	615-678-7641

Provider Business Practice Location Address
First Line	:	2711 FOSTER AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-5307
Country	:	US
Telephone Number	:	615-227-3000
Fax Number	:	615-678-7641

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/11/2017

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