MEDICARE: FRED J SESTI 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	363L00000X	Nurse Practitioner	APN0000007704	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	500029367	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1174618516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED J SESTI FNP

Provider Business Mailing Address
First Line	:	31 PHYSICIANS DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2071
Country	:	US
Telephone Number	:	731-664-0103
Fax Number	:	731-664-5666

Provider Business Practice Location Address
First Line	:	31 PHYSICIANS DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2071
Country	:	US
Telephone Number	:	731-664-0103
Fax Number	:	731-664-5666

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/29/2016

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Directions to “ FRED J SESTI FNP” Practice Location

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