Healthcare Provider Details

I. General information

NPI: 1568636785
Provider Name (Legal Business Name): PENELOPE JOY BUMPUS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 21ST AVE S
NASHVILLE TN
37212-5601
US

IV. Provider business mailing address

2525 21ST AVENUE SOUTH NASHVILLE SKIN AND CANCER
NASHVILLE TN
37212-5601
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-9797
  • Fax: 615-613-0329
Mailing address:
  • Phone: 615-327-9797
  • Fax: 615-613-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000010889
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: