Healthcare Provider Details

I. General information

NPI: 1255382388
Provider Name (Legal Business Name): JOHNNA LEA BEUERLEIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 11/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176C W UNIVERSITY PKWY # C
JACKSON TN
38305-1616
US

IV. Provider business mailing address

176C W UNIVERSITY PKWY # C
JACKSON TN
38305-1616
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-6915
  • Fax: 731-668-4557
Mailing address:
  • Phone: 731-660-6915
  • Fax: 731-668-4557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN6364
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: