Provider Demographics
NPI:1003449398
Name:BUMP, NATHANIEL LEVI (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:LEVI
Last Name:BUMP
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8912 OAK GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9354
Mailing Address - Country:US
Mailing Address - Phone:901-848-3317
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE STE 807
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5218
Practice Address - Country:US
Practice Address - Phone:901-762-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27228363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner