Healthcare Provider Details

I. General information

NPI: 1598569253
Provider Name (Legal Business Name): VANESSA JANE KUMPF PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 21ST AVE S # MAB514
NASHVILLE TN
37212-2717
US

IV. Provider business mailing address

1211 21ST AVE S # MAB514
NASHVILLE TN
37212-2717
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-2737
  • Fax: 615-936-0006
Mailing address:
  • Phone: 615-322-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number0000027031
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: