Healthcare Provider Details

I. General information

NPI: 1891192787
Provider Name (Legal Business Name): SYRETTA PERKINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 RAMSEY WAY
DICKSON TN
37055-1087
US

IV. Provider business mailing address

131 SAUNDERSVILLE RD SUITE 160
HENDERSONVILLE TN
37075-8903
US

V. Phone/Fax

Practice location:
  • Phone: 615-441-2963
  • Fax:
Mailing address:
  • Phone: 615-824-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000019361
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19361
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: