MEDICARE: TIMOTHY ALLEN NAUMANN 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
1	363LF0000X	Family Nurse Practitioner	19570	SC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	19570	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992188379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY ALLEN NAUMANN FNP-BC

Provider Business Mailing Address
First Line	:	251 WALL ST
Second Line	:
City	:	PIEDMONT
State	:	SC
Zip	:	29673-6754
Country	:	US
Telephone Number	:	864-597-0159
Fax Number	:	864-685-7676

Provider Business Practice Location Address
First Line	:	251 WALL ST
Second Line	:
City	:	PIEDMONT
State	:	SC
Zip	:	29673-6754
Country	:	US
Telephone Number	:	864-597-0159
Fax Number	:	863-685-7676

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

Provider Enumeration Date	:	07/03/2015
Last Update Date	:	10/29/2024

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