MEDICARE: CALEB FRESH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	34244	TN
2	363LA2200X	Adult Health Nurse Practitioner	34244	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013691146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB FRESH NP

Provider Business Mailing Address
First Line	:	521 STONECREST PKWY STE 200
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6885
Country	:	US
Telephone Number	:	615-223-9935
Fax Number	:	615-891-5046

Provider Business Practice Location Address
First Line	:	521 STONECREST PKWY STE 200
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6885
Country	:	US
Telephone Number	:	615-223-9935
Fax Number	:	615-891-5046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2023
Last Update Date	:	02/03/2026

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Directions to “ CALEB FRESH NP” Practice Location

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