MEDICARE: JULIA ALEXANDRA BYRD

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	363LP0200X	Pediatric Nurse Practitioner	25323	TN

General Provider Information

NPI Number	:	1407311392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA ALEXANDRA BYRD

Provider Business Mailing Address
First Line	:	218 HICKORY POINTE DR
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-5009
Country	:	US
Telephone Number	:	615-519-5649
Fax Number	:

Provider Business Practice Location Address
First Line	:	739 PRESIDENT PL STE 110
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6845
Country	:	US
Telephone Number	:	615-625-7780
Fax Number	:

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

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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