Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 23839 | TN |
NPI | 1003323148 |
---|---|
Provider Name | Mrs. Joanna Ferrell |
First Address | Clarksville, TN 37043-2231 |
Second Address | Clarksville, TN 37043-2231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 05/02/2018 |