=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316796337
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI M MARLOW AGNP-CB
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2024
-----------------------------------------------------
Last Update Date | 02/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2221 JACKSBORO PIKE STE A18
-----------------------------------------------------
City | LA FOLLETTE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37766-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-333-4770
-----------------------------------------------------
Fax | 865-332-1923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2221 JACKSBORO PIKE STE A18
-----------------------------------------------------
City | LA FOLLETTE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37766-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-408-7606
-----------------------------------------------------
Fax | 865-332-1923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 36298
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------