Provider Demographics
NPI:1134651128
Name:GREENWOOD, AUSTIN TAYLOR (FNP)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:TAYLOR
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2358 LIFESTYLE WAY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2291
Mailing Address - Country:US
Mailing Address - Phone:423-521-1100
Mailing Address - Fax:423-521-1200
Practice Address - Street 1:4230 PHILIPS FARM RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-0067
Practice Address - Country:US
Practice Address - Phone:573-882-4800
Practice Address - Fax:573-884-0723
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN22474207N00000X, 363L00000X, 363LF0000X
MO2023032737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner