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NPI Code Detail

MEDICARE: DELTA CLINICS, P.L.C.

MEDICARE: DELTA CLINICS, P.L.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
1363LF0000XFamily Nurse PractitionerAPN0000022418TN

General Provider Information

NPI Number : 1578004453
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELTA CLINICS, P.L.C.
Provider Business Mailing Address
First Line : 17 CENTRE PLAZA DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-2862
Country : US
Telephone Number : 731-512-0104
Fax Number :
Provider Business Practice Location Address
First Line : 17 CENTRE PLAZA DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-2862
Country : US
Telephone Number : 731-512-0104
Fax Number :
Authorized Official
Title or Position : PRACTICE MANAGER
Name : MEAGAN HARDISON
Credential :
Telephone Number : 731-512-0104
Provider Enumeration Date : 03/13/2017
Last Update Date : 05/06/2026

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