Healthcare Provider Details

I. General information

NPI: 1275198327
Provider Name (Legal Business Name): IRENE ELIZABETH GREGORY FNP-BC, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE ELIZABETH RUSSELL

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTHCREST DR
SPRINGFIELD TN
37172-3927
US

IV. Provider business mailing address

100 NORTHCREST DR
SPRINGFIELD TN
37172-3927
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-2411
  • Fax:
Mailing address:
  • Phone: 615-384-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number198102
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25855
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number25855
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: