Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 44653 | TN |
Y | 208600000X | Surgeon | 44653 | TN |
NPI | 1013165505 |
---|---|
Provider Name | Dr. Kristina Dare O'shaughnessy |
First Address | Franklin, TN 37067-8235 |
Second Address | Franklin, TN 37067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2008 |
Last Update Date | 12/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1523087 | (05) | TN |