Healthcare Provider Details

I. General information

NPI: 1407163868
Provider Name (Legal Business Name): ALLISON CUMMINGS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 PHYSICIANS DR
JACKSON TN
38305-6011
US

IV. Provider business mailing address

121 PHYSICIANS DR
JACKSON TN
38305-6011
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-5050
  • Fax:
Mailing address:
  • Phone: 731-664-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15254
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number136976
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: