Healthcare Provider Details

I. General information

NPI: 1295154482
Provider Name (Legal Business Name): PULASKI PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E COLLEGE ST
PULASKI TN
38478-4520
US

IV. Provider business mailing address

1125 E COLLEGE ST
PULASKI TN
38478-4520
US

V. Phone/Fax

Practice location:
  • Phone: 931-424-5437
  • Fax: 931-424-5448
Mailing address:
  • Phone: 931-424-5437
  • Fax: 931-424-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37925
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000011697
License Number StateTN

VIII. Authorized Official

Name: DR. MILDRED ANGELES FRANCO-CHEN
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 931-424-5437