Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 20681 | TN |
NPI | 1023480084 |
---|---|
Provider Name | Mark Priestley |
First Address | Nashville, TN 37232-0011 |
Second Address | Nashville, TN 37232-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2015 |
Last Update Date | 29/10/2015 |