Healthcare Provider Details

I. General information

NPI: 1275168080
Provider Name (Legal Business Name): TAD DUANE WARD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 HIGHWAY 114 S
SCOTTS HILL TN
38374-5023
US

IV. Provider business mailing address

P O BOX 187 644 HIGHWAY 114 S
SCOTTS HILL TN
38374-5023
US

V. Phone/Fax

Practice location:
  • Phone: 731-549-1000
  • Fax: 731-549-1011
Mailing address:
  • Phone: 731-549-1000
  • Fax: 731-549-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27178
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: