Healthcare Provider Details

I. General information

NPI: 1427524982
Provider Name (Legal Business Name): REBECCA FAYE SKILLERN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7729 WRIGHT RIDGE RD
IRON CITY TN
38463-4100
US

IV. Provider business mailing address

7729 WRIGHT RIDGE RD
IRON CITY TN
38463-4100
US

V. Phone/Fax

Practice location:
  • Phone: 931-724-4397
  • Fax:
Mailing address:
  • Phone: 931-724-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25088
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: