Healthcare Provider Details

I. General information

NPI: 1952796575
Provider Name (Legal Business Name): MARY HOUSTON HULL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N MAIN ST
MOUNT PLEASANT TN
38474-1017
US

IV. Provider business mailing address

701 SHENANDOAH DR
COLUMBIA TN
38401-6120
US

V. Phone/Fax

Practice location:
  • Phone: 931-379-3229
  • Fax:
Mailing address:
  • Phone: 931-797-4952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number180607
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19803
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: