Healthcare Provider Details

I. General information

NPI: 1922684919
Provider Name (Legal Business Name): RACHEL ALEXANDRA NELSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 06/18/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GARRETT DR
MEDINA TN
38355-9641
US

IV. Provider business mailing address

PO BOX 400
JACKSON TN
38302-0400
US

V. Phone/Fax

Practice location:
  • Phone: 731-422-0355
  • Fax: 731-462-5070
Mailing address:
  • Phone: 731-423-8697
  • Fax: 731-425-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO5468
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: