Provider Demographics
NPI:1396098380
Name:BUTUNGANE-SEXTON, MWAKA ALICE (FNP)
Entity type:Individual
Prefix:
First Name:MWAKA
Middle Name:ALICE
Last Name:BUTUNGANE-SEXTON
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 1:4901 NOLENSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5411
Mailing Address - Country:US
Mailing Address - Phone:615-575-3783
Mailing Address - Fax:877-259-8932
Practice Address - Street 1:4901 NOLENSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5411
Practice Address - Country:US
Practice Address - Phone:615-575-3783
Practice Address - Fax:877-259-8932
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT290916899OtherMEDICARE
TN0000016946OtherAPN
TNQ000205Medicaid