Provider Demographics
NPI:1972575512
Name:UNDERWOOD, BOBBY (CRNFA)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 HAY LONG AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TN
Mailing Address - Zip Code:38474-1434
Mailing Address - Country:US
Mailing Address - Phone:931-379-4092
Mailing Address - Fax:
Practice Address - Street 1:409 HAY LONG AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474-1434
Practice Address - Country:US
Practice Address - Phone:931-379-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000105025163WG0000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice