Healthcare Provider Details

I. General information

NPI: 1952871055
Provider Name (Legal Business Name): GLENDA PULLIAM A-GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 NAVY RD
MILLINGTON TN
38053-2030
US

IV. Provider business mailing address

4879 NAVY RD
MILLINGTON TN
38053-2030
US

V. Phone/Fax

Practice location:
  • Phone: 704-449-6400
  • Fax: 877-800-9150
Mailing address:
  • Phone: 704-449-6400
  • Fax: 877-800-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number32063
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number22404
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5012679
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number32063
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: