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NPI 1083565733 · on the registry since 2026

Practice

Address
135 Manor Way Apt C
Louisville, TN 37777
Phone
(717) 575-2732
Fax
(717) 575-2732

Registry record

Primary taxonomy
103K00000X
103K00000X
Licence states on file
TN
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2026-02-09

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Tennessee