MEDICARE: REBECCA A GRIGGS GALYEAN DNP

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	8256	TN

General Provider Information

NPI Number	:	1578665709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA A GRIGGS GALYEAN DNP

Provider Business Mailing Address
First Line	:	21 SECURITY DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3626
Country	:	US
Telephone Number	:	731-661-9163
Fax Number	:	731-664-9916

Provider Business Practice Location Address
First Line	:	21 SECURITY DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3626
Country	:	US
Telephone Number	:	731-661-9163
Fax Number	:	731-664-9916

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	10/23/2024

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