=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326252685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA MAE MCDOUGALL NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1321 CEDAR LN
-----------------------------------------------------
City | TULLAHOMA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37388-2227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-222-4207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2717 E OAKLAND AVE
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37601-1843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-926-2358
-----------------------------------------------------
Fax | 423-926-2680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 37847
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------