Basic Information
| Provider Information | |||||||||
| NPI: | 1639160120 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIFFITH | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | APN NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3799 | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370433799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312458500 | ||||||||
| FaxNumber: | 9312457068 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 HILLCREST DR | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370435093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312458500 | ||||||||
| FaxNumber: | 9312457068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5655APN | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3908556 | 05 | TN | MEDICAID |