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NPI Code Detail

MEDICARE: JAMES DALTON TETLETON FNP-BC

MEDICARE: JAMES DALTON TETLETON FNP-BC
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
1363LF0000XFamily Nurse Practitioner17409TN

General Provider Information

NPI Number : 1891035044
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES DALTON TETLETON FNP-BC
Provider Business Mailing Address
First Line : 1445 US HIGHWAY 51 BYP E
Second Line :
City : DYERSBURG
State : TN
Zip : 38024-2127
Country : US
Telephone Number : 731-286-1900
Fax Number : 731-286-1939
Provider Business Practice Location Address
First Line : 1445 US HIGHWAY 51 BYP E
Second Line :
City : DYERSBURG
State : TN
Zip : 38024-2127
Country : US
Telephone Number : 731-286-1900
Fax Number : 731-286-1939
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2013
Last Update Date : 10/07/2014

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