MEDICARE: JOAN CORNELIA MCCUEN APN, PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN0000008438	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4087312	OTHER	TN	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1023147766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN CORNELIA MCCUEN APN, PH.D.

Provider Business Mailing Address
First Line	:	728 MOLALLA AVE
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045
Country	:	US
Telephone Number	:	503-656-9030
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 21ST AVE S STE 305
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-4929
Country	:	US
Telephone Number	:	615-310-8551
Fax Number	:	615-292-9323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	11/18/2015

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