Healthcare Provider Details

I. General information

NPI: 1720452360
Provider Name (Legal Business Name): JOSHUA MCWATERS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 S HARTMANN DR
LEBANON TN
37090-4064
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 615-321-0200
  • Fax: 615-443-5488
Mailing address:
  • Phone: 615-329-9924
  • Fax: 615-695-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number274849317
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: