=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114809738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAZIE BIVENS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4798 NEW HIGHWAY 68
-----------------------------------------------------
City | MADISONVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37354-1287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-442-2622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1759 GRAND PINE PT
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37801-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-836-3560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 38983
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 253982
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------