Healthcare Provider Details

I. General information

NPI: 1275665846
Provider Name (Legal Business Name): CAROL G BURKHEAD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 HWY 114 SOUTH SCOTTS HILL CLINIC
SCOTTS HILL TN
38374-0099
US

IV. Provider business mailing address

8800 HIGHWAY 100
SCOTTS HILL TN
38374-5007
US

V. Phone/Fax

Practice location:
  • Phone: 731-549-3191
  • Fax: 731-549-3005
Mailing address:
  • Phone: 731-549-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000005284
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: