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General NPI Number Information
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NPI Number | 1366717985
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Entity Type | Organization
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Legal Business Name | TRAYLOR FAMILY HEALTH,LLC
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 5923 EAST MAIN STREET
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City | ERIN
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State | TN
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Zip | 37061
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Country | US
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Telephone | 931-206-1161
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Fax | 931-387-3935
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Provider Business Mailing Address
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Address Line | PO BOX 128
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City | CUNNINGHAM
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State | TN
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Zip | 37052-0128
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Country | US
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Telephone | 931-206-1161
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Fax | 931-387-3935
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Authorized Official
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Title or Position | CHIEF MANAGER/NURSE PRACTITIONER
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Name | JAMIE V TRAYLOR
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Credential | FNP
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Telephone | 931-206-1161
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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 | 7798
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License Number State | TN
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