Healthcare Provider Details

I. General information

NPI: 1841339777
Provider Name (Legal Business Name): MICHIE HEALTHCARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5823 HIGHWAY 22
MICHIE TN
38357-5175
US

IV. Provider business mailing address

5823 HIGHWAY 22
MICHIE TN
38357-5175
US

V. Phone/Fax

Practice location:
  • Phone: 731-239-9470
  • Fax: 901-239-9472
Mailing address:
  • Phone: 731-239-9470
  • Fax: 901-239-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000006154
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000005664
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000006345
License Number StateTN

VIII. Authorized Official

Name: DEE BLAKNEY
Title or Position: PARTNER
Credential: FNP
Phone: 731-239-9470