Healthcare Provider Details

I. General information

NPI: 1245639327
Provider Name (Legal Business Name): SELENA PHILLIPS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 FAIRVIEW BLVD
FAIRVIEW TN
37062-9088
US

IV. Provider business mailing address

7129 DONALD WILSON DR
FAIRVIEW TN
37062-7265
US

V. Phone/Fax

Practice location:
  • Phone: 615-799-0101
  • Fax:
Mailing address:
  • Phone: 615-319-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19012
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: