Healthcare Provider Details

I. General information

NPI: 1265228159
Provider Name (Legal Business Name): MARY ALICE SPAULDING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 07/03/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S CROSS BRIDGES RD
MT PLEASANT TN
38474-1714
US

IV. Provider business mailing address

201 W HARDIN DR
COLUMBIA TN
38401-2044
US

V. Phone/Fax

Practice location:
  • Phone: 931-379-5821
  • Fax: 931-379-5867
Mailing address:
  • Phone: 615-975-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37786
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: