Healthcare Provider Details

I. General information

NPI: 1699046235
Provider Name (Legal Business Name): MATRIX WELLNESS SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 CARRIAGE HOUSE DR STE D SUITE D
JACKSON TN
38305-2268
US

IV. Provider business mailing address

384 CARRIAGE HOUSE DR STE D SUITE D
JACKSON TN
38305-2268
US

V. Phone/Fax

Practice location:
  • Phone: 731-256-2006
  • Fax: 731-256-2007
Mailing address:
  • Phone: 731-256-2006
  • Fax: 731-256-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN 007296
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN0013215
License Number StateTN

VIII. Authorized Official

Name: MR. DAVID BRIAN HUGHES
Title or Position: C0-OWNER
Credential: GNP
Phone: 731-571-8808