Healthcare Provider Details

I. General information

NPI: 1558305227
Provider Name (Legal Business Name): MARY T DYESS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY FRANCES TOMPKINS APRN

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OMNI DR CHEER MENTAL HEALTH
MCMINNVILLE TN
37110-1331
US

IV. Provider business mailing address

120 OMNI DR CHEER MENTAL HEALTH
MCMINNVILLE TN
37110-1331
US

V. Phone/Fax

Practice location:
  • Phone: 931-473-9649
  • Fax: 931-456-6916
Mailing address:
  • Phone: 931-473-9649
  • Fax: 931-456-6916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number828652
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN0000015847
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: