Healthcare Provider Details

I. General information

NPI: 1336309806
Provider Name (Legal Business Name): GERIATRIX CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 N MOUNT JULIET RD #220
MOUNT JULIET TN
37122-3315
US

IV. Provider business mailing address

PO BOX 1184
LEBANON TN
37088-1184
US

V. Phone/Fax

Practice location:
  • Phone: 615-773-7775
  • Fax:
Mailing address:
  • Phone: 615-686-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN10671
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateTN

VIII. Authorized Official

Name: MRS. KRISTY ANNE ROACH
Title or Position: OWNER
Credential: N.P.
Phone: 615-686-7773