Healthcare Provider Details

I. General information

NPI: 1386699361
Provider Name (Legal Business Name): MARY SUE RHOADS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6659 MICHIE PEBBLE HILL RD
MICHIE TN
38357-5115
US

IV. Provider business mailing address

PO BOX 297
MICHIE TN
38357-0297
US

V. Phone/Fax

Practice location:
  • Phone: 731-632-1783
  • Fax: 731-632-1786
Mailing address:
  • Phone: 731-632-1783
  • Fax: 731-632-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000006617
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: