Healthcare Provider Details

I. General information

NPI: 1073805529
Provider Name (Legal Business Name): SAMANTHA A WHITWELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N LOCUST AVE
LAWRENCEBURG TN
38464-3757
US

IV. Provider business mailing address

110 N HIGH ST
MT PLEASANT TN
38474-1137
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-7232
  • Fax:
Mailing address:
  • Phone: 931-215-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15808
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: