MEDICARE: BETH HENSON 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	18996	TN

General Provider Information

NPI Number	:	1780085761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH HENSON DNP

Provider Business Mailing Address
First Line	:	80 ENOCH BLVD STE A
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-2230
Country	:	US
Telephone Number	:	731-926-4222
Fax Number	:	731-926-4228

Provider Business Practice Location Address
First Line	:	80 ENOCH BLVD STE A
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-2230
Country	:	US
Telephone Number	:	731-926-4222
Fax Number	:	731-926-4228

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

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	09/10/2014

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