Healthcare Provider Details

I. General information

NPI: 1255031357
Provider Name (Legal Business Name): JOSHUA BURSON TRUESDELL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N OCOEE ST
CLEVELAND TN
37311-3850
US

IV. Provider business mailing address

2350 N OCOEE ST
CLEVELAND TN
37311-3850
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-5554
  • Fax: 423-614-6116
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: