=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306496054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASS FAMILY HEALTH CLINIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2019
-----------------------------------------------------
Last Update Date | 11/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 933 TRACY LN STE D
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37040-6894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-667-6799
-----------------------------------------------------
Fax | 833-450-5889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 933 TRACY LN STE D
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37040-6894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-667-6799
-----------------------------------------------------
Fax | 833-450-5889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FNP
-----------------------------------------------------
Name | TESSA MORRISON
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 615-667-6799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------