Provider Demographics
NPI:1760717953
Name:SHUTT, GAIL L (FNP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:SHUTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 DAVES HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6506
Mailing Address - Country:US
Mailing Address - Phone:931-433-3143
Mailing Address - Fax:
Practice Address - Street 1:289 DAVES HOLLOW RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-6506
Practice Address - Country:US
Practice Address - Phone:931-433-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily