Healthcare Provider Details

I. General information

NPI: 1851367197
Provider Name (Legal Business Name): KAREN SALVAGGIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 NUCKOLLS RD
BOLIVAR TN
38008-1599
US

IV. Provider business mailing address

PO BOX 720
BOLIVAR TN
38008-0720
US

V. Phone/Fax

Practice location:
  • Phone: 731-658-3388
  • Fax: 731-658-4079
Mailing address:
  • Phone: 731-659-3125
  • Fax: 731-659-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN6367
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN81212
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: