Healthcare Provider Details

I. General information

NPI: 1902881907
Provider Name (Legal Business Name): TARA D WATSON-POST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 HAWKINS BRANCH RD
BETHPAGE TN
37022-4626
US

IV. Provider business mailing address

3185 HAWKINS BRANCH RD
BETHPAGE TN
37022-4626
US

V. Phone/Fax

Practice location:
  • Phone: 615-478-0637
  • Fax:
Mailing address:
  • Phone: 615-478-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2124
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN5423
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: