Healthcare Provider Details

I. General information

NPI: 1912990540
Provider Name (Legal Business Name): SHANNA JOY GAITHER ANPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNA JOY DAVENPORT

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 THE VANDERBILT CLINIC
NASHVILLE TN
37232-0001
US

IV. Provider business mailing address

3601 TVC
NASHVILLE TN
37232-0001
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-4153
  • Fax:
Mailing address:
  • Phone: 615-322-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN10458
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10458
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: