MEDICARE: ELIZABETH ANN UNDERWOOD

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	363AM0700X	Medical Physician Assistant	6678	TN

General Provider Information

NPI Number	:	1861238271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN UNDERWOOD

Provider Business Mailing Address
First Line	:	221 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3962
Country	:	US
Telephone Number	:	615-384-2149
Fax Number	:	855-406-7510

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

Provider Enumeration Date	:	07/04/2024
Last Update Date	:	12/04/2025

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