Provider Demographics
NPI:1528033016
Name:RAWLS, CONNIE ELAINE (FNPC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:ELAINE
Last Name:RAWLS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 STONEGATE PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4388
Mailing Address - Country:US
Mailing Address - Phone:615-376-7820
Mailing Address - Fax:
Practice Address - Street 1:1420 W BADDOUR PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1510
Practice Address - Country:US
Practice Address - Phone:615-453-3645
Practice Address - Fax:615-453-2675
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5654363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care