Healthcare Provider Details

I. General information

NPI: 1073879995
Provider Name (Legal Business Name): BETTENA WITHERSPOON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 W NORTHFIELD BLVD STE 3
MURFREESBORO TN
37129-1539
US

IV. Provider business mailing address

1132 TIGER WOODS WAY
MURFREESBORO TN
37129-7480
US

V. Phone/Fax

Practice location:
  • Phone: 615-896-5864
  • Fax:
Mailing address:
  • Phone: 615-513-3003
  • Fax: 615-367-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number156347
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16193
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: