Healthcare Provider Details

I. General information

NPI: 1578558185
Provider Name (Legal Business Name): WILLARD SCOTT MEADOWS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SCOTT MEADOWS CRNA

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 HWY 70 E
DICKSON TN
37055-2111
US

IV. Provider business mailing address

PO BOX 299
MANCHESTER TN
37349-0299
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-2320
  • Fax: 615-620-2323
Mailing address:
  • Phone: 931-728-5607
  • Fax: 931-728-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP5193A
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN10816
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN106855
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: