Healthcare Provider Details

I. General information

NPI: 1669926275
Provider Name (Legal Business Name): AUBREY NUNLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 MAIN ST
PALMER TN
37365-2531
US

IV. Provider business mailing address

PO BOX 70
PALMER TN
37365-0070
US

V. Phone/Fax

Practice location:
  • Phone: 931-779-3966
  • Fax:
Mailing address:
  • Phone: 931-625-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43433
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: