Provider Demographics
NPI:1366094807
Name:ANDERSON, ELIZABETH POWELL (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:POWELL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-5671
Mailing Address - Country:US
Mailing Address - Phone:731-587-3830
Mailing Address - Fax:
Practice Address - Street 1:1720 E REELFOOT AVE STE 103
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6048
Practice Address - Country:US
Practice Address - Phone:731-885-6600
Practice Address - Fax:731-885-9239
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN621839639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine