Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 15935 | TN |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 15935 | TN |
NPI | 1003194044 |
---|---|
Provider Name | Mrs. Tasma Graham Robertson |
First Address | Jackson, TN 38305-7526 |
Second Address | Whiteville, TN 38075-7526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 15/12/2021 |