MEDICARE: ADDISON RAGAN WHNP

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	363LW0102X	Women's Health Nurse Practitioner	37119	TN
2	207V00000X	Obstetrics & Gynecology Physician	37119	TN

General Provider Information

NPI Number	:	1942024609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADDISON RAGAN WHNP

Provider Business Mailing Address
First Line	:	5306 WALNUT CHASE DR
Second Line	:
City	:	CHRISTIANA
State	:	TN
Zip	:	37037-2037
Country	:	US
Telephone Number	:	309-737-1142
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 STONECREST BLVD STE 310
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6801
Country	:	US
Telephone Number	:	629-206-6858
Fax Number	:

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

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	04/17/2026

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