Healthcare Provider Details

I. General information

NPI: 1164745998
Provider Name (Legal Business Name): DEBORAH S NALE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CARL PERKINS PKWY
TIPTONVILLE TN
38079-1678
US

IV. Provider business mailing address

710 CARL PERKINS PKWY
TIPTONVILLE TN
38079-1678
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57499
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: