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General NPI Number Information
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NPI Number | 1104864602
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Entity Type | Individual
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Provider Name | GWEN A GUEGOLD F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 3360 HIGHWAY 411 N
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City | ENGLEWOOD
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State | TN
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Zip | 37329-5276
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Country | US
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Telephone | 423-887-5131
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Fax | 423-887-5917
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Provider Business Mailing Address
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Address Line | 6350 W ANDREW JOHNSON HWY DEPARTMENT 100
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City | TALBOTT
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State | TN
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Zip | 37877-8605
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Country | US
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Telephone | 800-355-3565
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Fax | 423-714-2355
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5518
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN5518
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN49800
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License Number State | TN
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