MEDICARE: FAWN CRESS FNP

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	6306	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	:	1154351278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAWN CRESS FNP

Provider Business Mailing Address
First Line	:	1204 N HOUSTON LEVEE RD STE 114
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-6687
Country	:	US
Telephone Number	:	901-421-5000
Fax Number	:	901-227-0499

Provider Business Practice Location Address
First Line	:	1204 N HOUSTON LEVEE RD STE 114
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-6687
Country	:	US
Telephone Number	:	901-421-5000
Fax Number	:	901-901-5721

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	02/14/2024

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