Healthcare Provider Details

I. General information

NPI: 1982955985
Provider Name (Legal Business Name): JOEL WYATT CAMPBELL NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

V. Phone/Fax

Practice location:
  • Phone: 615-873-7472
  • Fax:
Mailing address:
  • Phone: 615-873-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16099
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: