MEDICARE: MICHELLE S. MIX FNP

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	19827	TN
2	363LF0000X	Family Nurse Practitioner	R 204496-7	MN

General Provider Information

NPI Number	:	1326319013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE S. MIX FNP

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	COLLEGEDALE
State	:	TN
Zip	:	37315-0370
Country	:	US
Telephone Number	:	423-236-2713
Fax Number	:	423-236-1713

Provider Business Practice Location Address
First Line	:	4687 UNIVERSITY DR
Second Line	:
City	:	COLLEGE DALE
State	:	TN
Zip	:	37363-8472
Country	:	US
Telephone Number	:	423-236-2713
Fax Number	:

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

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	04/15/2026

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