Provider Demographics
NPI:1518580679
Name:RAGLAND, GWEN
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:RAGLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 WILEY PARKER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2226
Mailing Address - Country:US
Mailing Address - Phone:731-203-0708
Mailing Address - Fax:877-540-0067
Practice Address - Street 1:460 N PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2818
Practice Address - Country:US
Practice Address - Phone:314-313-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator