Healthcare Provider Details

I. General information

NPI: 1093757551
Provider Name (Legal Business Name): RAMONA PHELAN SCARBOROUGH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 SUMMAR DR
JACKSON TN
38301-3906
US

IV. Provider business mailing address

1804 HIGHWAY 45 BYP SUITE 604
JACKSON TN
38305-4436
US

V. Phone/Fax

Practice location:
  • Phone: 731-935-8200
  • Fax: 731-935-8327
Mailing address:
  • Phone: 731-660-8759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number50377
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: