Healthcare Provider Details

I. General information

NPI: 1326028952
Provider Name (Legal Business Name): MARGARET DISHEROON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET HUSKEY

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/05/2020
Certification Date: 01/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8967 DAYTON PIKE
SODDY DAISY TN
37379-4311
US

IV. Provider business mailing address

2401 DECHERD BLVD
WINCHESTER TN
37398-1164
US

V. Phone/Fax

Practice location:
  • Phone: 423-451-7623
  • Fax: 423-451-7677
Mailing address:
  • Phone: 931-313-1388
  • Fax: 931-313-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number87021
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6517
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6517
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: