MEDICARE: PATRICE VIVIENNE HENRY APRN

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	363LF0000X	Family Nurse Practitioner	APN0000024554	TN

General Provider Information

NPI Number	:	1063989150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE VIVIENNE HENRY APRN

Provider Business Mailing Address
First Line	:	6508 SATJANON DR
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-7296
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6508 SATJANON DR
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-7296
Country	:	US
Telephone Number	:	--
Fax Number	:

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

Provider Enumeration Date	:	10/27/2018
Last Update Date	:	03/25/2026

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