MEDICARE: JUAN CARLOS ZULUAGA BEDOYA P.A., RN, SA-C,

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	363AS0400X	Surgical Physician Assistant	3009	PR
2	363A00000X	Physician Assistant	3009	PR
3	246ZC0007X	Surgical Assistant	20-104	TN
4	163W00000X	Registered Nurse	272280	TN

General Provider Information

NPI Number	:	1568092872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS ZULUAGA BEDOYA P.A., RN, SA-C,

Provider Business Mailing Address
First Line	:	5836 STONECREST DR
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-0226
Country	:	US
Telephone Number	:	901-626-4635
Fax Number	:

Provider Business Practice Location Address
First Line	:	5836 STONECREST DR
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-0226
Country	:	US
Telephone Number	:	901-626-4635
Fax Number	:

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

Provider Enumeration Date	:	01/26/2020
Last Update Date	:	03/02/2026

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