Healthcare Provider Details

I. General information

NPI: 1851907703
Provider Name (Legal Business Name): CHRISTEN WIEDOWER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 WOLF RIVER BLVD
GERMANTOWN TN
38138-1762
US

IV. Provider business mailing address

7945 WOLF RIVER BLVD
GERMANTOWN TN
38138-1762
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0055
  • Fax:
Mailing address:
  • Phone: 901-683-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904140
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number28212
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: