Healthcare Provider Details

I. General information

NPI: 1982089157
Provider Name (Legal Business Name): TINERA HUTCHINS-CONRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1589 SPARTA ST STE 100
MCMINNVILLE TN
37110-1392
US

IV. Provider business mailing address

1589 SPARTA STREET STE 100
MCMINNVILLE TN
37110-1392
US

V. Phone/Fax

Practice location:
  • Phone: 800-345-5016
  • Fax: 931-815-3423
Mailing address:
  • Phone: 800-345-5016
  • Fax: 931-815-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20226
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: