MEDICARE: JASON PIYAVUNNO 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	363L00000X	Nurse Practitioner	29842	TN

General Provider Information

NPI Number	:	1861164121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON PIYAVUNNO FNP-C

Provider Business Mailing Address
First Line	:	3960 NEW COVINGTON PIKE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 NEW COVINGTON PIKE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2589
Country	:	US
Telephone Number	:	901-516-5200
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	03/29/2022

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