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General NPI Number Information
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NPI Number | 1265418966
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Entity Type | Individual
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Provider Name | MARY KAY FADDEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 617 S 8TH ST
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City | NASHVILLE
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State | TN
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Zip | 37206-3819
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Country | US
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Telephone | 615-228-8902
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Fax | 615-226-2679
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Provider Business Mailing Address
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Address Line | 601 W DUE WEST AVE
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City | MADISON
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State | TN
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Zip | 37115-4423
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Country | US
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Telephone | 615-425-3333
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Fax | 615-425-3348
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0000001679
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License Number State | TN
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