Healthcare Provider Details

I. General information

NPI: 1639650476
Provider Name (Legal Business Name): ALEXANDRA POPOVA RN,MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA SERGEYVNA POPOVA RN, MSN

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 10/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 8TH ST
CLARKSVILLE TN
37040-3093
US

IV. Provider business mailing address

610 SYLVAN HEIGHTS WAY APT 245
NASHVILLE TN
37209-4986
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0000225458
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number25025
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: