=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659086635
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA NOEL NERREN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2023
-----------------------------------------------------
Last Update Date | 01/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1754 N BROAD ST
-----------------------------------------------------
City | TAZEWELL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37879-4365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-491-7444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 161
-----------------------------------------------------
City | CUMBERLAND GAP
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37724-0161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-930-6869
-----------------------------------------------------
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 | 33183
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------