Healthcare Provider Details

I. General information

NPI: 1437063575
Provider Name (Legal Business Name): DENNETRIA WILMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 HIGHWAY 52 W
LAFAYETTE TN
37083-3274
US

IV. Provider business mailing address

5151 HIGHWAY 52 W
LAFAYETTE TN
37083-3274
US

V. Phone/Fax

Practice location:
  • Phone: 615-388-9216
  • Fax:
Mailing address:
  • Phone: 615-388-9216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07260739
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: