Provider Demographics
NPI:1497417232
Name:PROUDFOOT, SERENA (FNP-C)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:PROUDFOOT
Suffix:
Gender:F
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 1:26150 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-3158
Mailing Address - Country:US
Mailing Address - Phone:931-207-9297
Mailing Address - Fax:931-209-9298
Practice Address - Street 1:26150 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:TN
Practice Address - Zip Code:38449-3158
Practice Address - Country:US
Practice Address - Phone:931-207-9297
Practice Address - Fax:931-209-9298
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31302363LF0000X
ALF09211477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily