Healthcare Provider Details

I. General information

NPI: 1164635587
Provider Name (Legal Business Name): INA MAY GASKIN CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 SECOND RD.
SUMMERTOWN TN
38483-9626
US

IV. Provider business mailing address

41 THE FARM
SUMMERTOWN TN
38483-9626
US

V. Phone/Fax

Practice location:
  • Phone: 931-964-2293
  • Fax:
Mailing address:
  • Phone: 931-964-2519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM0000000021
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: