Healthcare Provider Details

I. General information

NPI: 1518373380
Provider Name (Legal Business Name): JOHNETTA CONAWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 8TH ST
CLARKSVILLE TN
37040-3093
US

IV. Provider business mailing address

2400 WHITE AVE
NASHVILLE TN
37204-2235
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 TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number84464
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: