=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912643289
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TESS LEIGHAN WILLIAMS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2022
-----------------------------------------------------
Last Update Date | 05/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 N MOUNT JULIET RD STE 104
-----------------------------------------------------
City | MOUNT JULIET
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37122-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-300-4847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6007 NE LIBERTY LN
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37087-8639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-483-1433
-----------------------------------------------------
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 | 29980
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------