=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043122153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DERMAL DYNAMICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2026
-----------------------------------------------------
Last Update Date | 09/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 GRANDSTAND BLVD
-----------------------------------------------------
City | GALLATIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37066-4600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-661-3332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 GRANDSTAND BLVD
-----------------------------------------------------
City | GALLATIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37066-4600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-661-3332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/NURSE PRACTITIONER
-----------------------------------------------------
Name | COURTNEY PEPPER HENSLEY
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 865-661-3332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------