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General NPI Number Information
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NPI Number | 1548794910
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Entity Type | Individual
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Provider Name | ALICIA LANDERS FNP
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Gender | Female
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 511 CHESTER LEVEE RD
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City | JACKSON
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State | TN
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Zip | 38301-7758
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Country | US
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Telephone | 731-695-3802
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 S HIGHLAND AVE
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City | JACKSON
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State | TN
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Zip | 38301-7718
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Country | US
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Telephone |
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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 | 22558
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License Number State | TN
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