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NPI Code Detail

MEDICARE: MARY KAY FADDEN PA-C

MEDICARE: MARY KAY FADDEN PA-C
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
1363A00000XPhysician AssistantPA0000001679TN

General Provider Information

NPI Number : 1265418966
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KAY FADDEN PA-C
Provider Business Mailing Address
First Line : 601 W DUE WEST AVE
Second Line :
City : MADISON
State : TN
Zip : 37115-4423
Country : US
Telephone Number : 615-425-3333
Fax Number : 615-425-3348
Provider Business Practice Location Address
First Line : 617 S 8TH ST
Second Line :
City : NASHVILLE
State : TN
Zip : 37206-3819
Country : US
Telephone Number : 615-228-8902
Fax Number : 615-226-2679
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 12/16/2010

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Directions to “ MARY KAY FADDEN PA-C” Practice Location

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