Healthcare Provider Details

I. General information

NPI: 1861578999
Provider Name (Legal Business Name): BLUEGRASS WOMEN'S HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 NEW SHACKLE ISLAND ROAD SUITE 244C
HENDERSONVILLE TN
37075-0000
US

IV. Provider business mailing address

353 NEW SHACKLE ISLAND ROAD SUITE 244C
HENDERSONVILLE TN
37075-0000
US

V. Phone/Fax

Practice location:
  • Phone: 615-826-1716
  • Fax: 615-826-4841
Mailing address:
  • Phone: 615-826-1716
  • Fax: 615-826-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN1217
License Number StateTN

VIII. Authorized Official

Name: MS. CELENA G WILLIAMS
Title or Position: NURSE PRACTITIONER
Credential: WHNP
Phone: 615-826-1716