Healthcare Provider Details

I. General information

NPI: 1316463821
Provider Name (Legal Business Name): DEBRA LYNN FOLKERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 UNION SCHOOL RD
GALLATIN TN
37066-2084
US

IV. Provider business mailing address

730 LOCK 5 RD
LEBANON TN
37087-8185
US

V. Phone/Fax

Practice location:
  • Phone: 615-206-1100
  • Fax:
Mailing address:
  • Phone: 615-838-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number79327
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: