Healthcare Provider Details

I. General information

NPI: 1457789380
Provider Name (Legal Business Name): COURTNEY FAUGHT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 07/15/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CARL PERKINS PKWY
TIPTONVILLE TN
38079-1678
US

IV. Provider business mailing address

1720 E REELFOOT AVE STE 200
UNION CITY TN
38261-6049
US

V. Phone/Fax

Practice location:
  • Phone: 731-253-6690
  • Fax: 731-253-6692
Mailing address:
  • Phone: 731-507-0272
  • Fax: 731-507-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN0000017625
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: