=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396470126
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MINDY LYNN MCMEANS MSN, APRN, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2022
-----------------------------------------------------
Last Update Date | 07/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 920 S HARTMANN DR STE 110
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37090-4137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-478-3464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 BERKSHIRE BLVD
-----------------------------------------------------
City | MOUNT JULIET
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37122-6036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-478-3464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 31923
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------