MEDICARE: JEANNIE AUVILLE SEABORN

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	363LF0000X	Family Nurse Practitioner	34723	TN

General Provider Information

NPI Number	:	1063291326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNIE AUVILLE SEABORN

Provider Business Mailing Address
First Line	:	915 S GARDEN ST
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 S GARDEN ST
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3205
Country	:	US
Telephone Number	:	931-548-8090
Fax Number	:

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

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	09/27/2023

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