Healthcare Provider Details

I. General information

NPI: 1376486977
Provider Name (Legal Business Name): EXQUISITE KROWNZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 OLD HICKORY BLVD STE B
HERMITAGE TN
37076-2586
US

IV. Provider business mailing address

5510 OLD HICKORY BLVD STE B
HERMITAGE TN
37076-2586
US

V. Phone/Fax

Practice location:
  • Phone: 615-779-1149
  • Fax:
Mailing address:
  • Phone: 615-779-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAYLA NICOLE WILSON
Title or Position: CRANIAL PROSTHESIS SPECIALIST
Credential:
Phone: 615-779-1149