Healthcare Provider Details

I. General information

NPI: 1942373717
Provider Name (Legal Business Name): STEVEN N MASHBURN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 N LOCUST AVE
LAWRENCEBURG TN
38464-2337
US

IV. Provider business mailing address

1822 CREEKSTONE DR
COLUMBIA TN
38401-6716
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-1800
  • Fax: 931-762-9155
Mailing address:
  • Phone: 931-490-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN0000007648
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000007648
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: