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General NPI Number Information
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NPI Number | 1174145759
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Entity Type | Individual
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Provider Name | SYNITA WOOTEN
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Gender | Female
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 05/18/2020
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Provider Practice Location Address
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Address Line | 200 HIGHWAY 52 BYP E
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City | LAFAYETTE
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State | TN
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Zip | 37083-1353
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Country | US
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Telephone | 615-821-0898
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Fax |
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Provider Business Mailing Address
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Address Line | 104 DAFFODIL DR
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City | DUDLEY
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State | NC
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Zip | 28333-5432
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Country | US
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Telephone | 919-288-4998
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 27558
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License Number State | TN
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