Healthcare Provider Details

I. General information

NPI: 1215989520
Provider Name (Legal Business Name): KAREN JANE PUCKETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N HIGHLAND AVE
MURFREESBORO TN
37130-2450
US

IV. Provider business mailing address

1041 N HIGHLAND AVE
MURFREESBORO TN
37130-2450
US

V. Phone/Fax

Practice location:
  • Phone: 615-617-3499
  • Fax: 615-617-3627
Mailing address:
  • Phone: 615-617-3499
  • Fax: 615-617-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number29252
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: