Individual provider Active NPI

Angela Lanette Gwyn, FNP-C

  • Family Nurse Practitioner
  • Murfreesboro, TN
National Provider Identifier
1790534337
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
36212 Issued in TN
Practice address
3400 Lebanon Rd
Murfreesboro, TN 37129-1392
Phone
(615) 867-6000
NPI assigned
May 15, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN.411332 OH
Nurse Practitioner 363L00000X APRN.CNP.0036059 OH
Family Nurse Practitioner 363LF0000X 36212 TN Primary

Addresses

Primary practice location

3400 Lebanon Rd
Murfreesboro, TN 37129-1392

Mailing address

PO Box 463
Cornersville, TN 37047-0463
Phone (419) 409-3117

Other practice location 1

2499 Lynnville Hwy # 463
Cornersville, TN 37047-5124
Phone (419) 409-3117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RN.411332OHMDRegistered Nurse
APRN.CNP.0036059OHMDNurse Practitioner
36212TNMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1790534337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 463",
            "city": "CORNERSVILLE",
            "state": "TN",
            "postal_code": "370470463",
            "telephone_number": "419-409-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 LEBANON RD",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371291392",
            "telephone_number": "615-867-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2499 Lynnville Hwy # 463",
            "address_purpose": "LOCATION",
            "city": "Cornersville",
            "state": "TN",
            "postal_code": "370475124",
            "country_code": "US",
            "telephone_number": "419-409-3117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GWYN",
        "first_name": "ANGELA",
        "middle_name": "LANETTE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.411332",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.0036059",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "36212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murfreesboro, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.