Individual
CHARLESTON BAILEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
157 W CHURCH ST, LEXINGTON, TN 38351-2011
(731) 968-8182
Mailing address
595 NATCHEZ TRACE DR, LEXINGTON, TN 38351-1627
(731) 307-9413
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
225188
TN
363LF0000X
Family Nurse Practitioner
Primary
30307
TN
Other
Enumeration date
06/18/2021
Last updated
09/22/2021
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