Provider Demographics
NPI:1275168080
Name:WARD, TAD DUANE (FNP)
Entity Type:Individual
Prefix:
First Name:TAD
Middle Name:DUANE
Last Name:WARD
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:P O BOX 187
Mailing Address - Street 2:644 HIGHWAY 114 S
Mailing Address - City:SCOTTS HILL
Mailing Address - State:TN
Mailing Address - Zip Code:38374-5023
Mailing Address - Country:US
Mailing Address - Phone:731-549-1000
Mailing Address - Fax:731-549-1011
Practice Address - Street 1:644 HIGHWAY 114 S
Practice Address - Street 2:
Practice Address - City:SCOTTS HILL
Practice Address - State:TN
Practice Address - Zip Code:38374-5023
Practice Address - Country:US
Practice Address - Phone:731-549-1000
Practice Address - Fax:731-549-1011
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily