Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 22544 | TN |
NPI | 1699288340 |
---|---|
Provider Name | Ms. Shannon Tamika Frazier |
First Address | Murfreesboro, TN 37128-0100 |
Second Address | Altamont, TN 37301-3626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2017 |
Last Update Date | 17/03/2018 |