Provider Demographics
NPI:1174618516
Name:SESTI, FRED J (FNP)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:J
Last Name:SESTI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2071
Mailing Address - Country:US
Mailing Address - Phone:731-664-0103
Mailing Address - Fax:731-664-5666
Practice Address - Street 1:31 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2071
Practice Address - Country:US
Practice Address - Phone:731-664-0103
Practice Address - Fax:731-664-5666
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN500029367OtherRAILROAD MEDICARE
TN3907058Medicaid
TN3907058Medicare ID - Type Unspecified
TNP02278Medicare UPIN