Healthcare Provider Details

I. General information

NPI: 1396808689
Provider Name (Legal Business Name): SEYMOUR MEDICAL CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10626 CHAPMAN HWY
SEYMOUR TN
37865-4703
US

IV. Provider business mailing address

10626 CHAPMAN HWY P.O. BOX 309
SEYMOUR TN
37865-4703
US

V. Phone/Fax

Practice location:
  • Phone: 865-577-5231
  • Fax: 865-577-1539
Mailing address:
  • Phone: 865-577-5231
  • Fax: 865-577-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN132917
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN71129
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN115867
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN0000012720
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO000645
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateTN

VIII. Authorized Official

Name: JENNIFER L NEAL
Title or Position: PRACTICE ADMIN
Credential:
Phone: 865-577-5231