MEDICARE: MEREDITH PAIGE GAITLEY FNP-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	163WG0000X	General Practice Registered Nurse	182924	TN
2	363LF0000X	Family Nurse Practitioner	F06221472	TN
3	363LF0000X	Family Nurse Practitioner	32486	TN

General Provider Information

NPI Number	:	1811634835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH PAIGE GAITLEY FNP-C

Provider Business Mailing Address
First Line	:	58 S BELLS ST
Second Line	:
City	:	ALAMO
State	:	TN
Zip	:	38001-1700
Country	:	US
Telephone Number	:	731-696-5401
Fax Number	:

Provider Business Practice Location Address
First Line	:	335 N FAIRGROUNDS ST
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-4726
Country	:	US
Telephone Number	:	731-426-2370
Fax Number	:

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

Provider Enumeration Date	:	05/19/2022
Last Update Date	:	09/17/2022

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