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NPI Code Detail

MEDICARE: TRACY PEVAHOUSE FNP

MEDICARE: TRACY PEVAHOUSE 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
1363LF0000XFamily Nurse Practitioner20862TN

General Provider Information

NPI Number : 1427416379
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY PEVAHOUSE FNP
Provider Business Mailing Address
First Line : 726 KENTUCKY AVE S
Second Line :
City : PARSONS
State : TN
Zip : 38363-3105
Country : US
Telephone Number : 731-847-6371
Fax Number : 731-847-2671
Provider Business Practice Location Address
First Line : 726 KENTUCKY AVE S
Second Line :
City : PARSONS
State : TN
Zip : 38363-3105
Country : US
Telephone Number : 731-847-6371
Fax Number : 731-847-2671
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2016
Last Update Date : 02/07/2016

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Directions to “ TRACY PEVAHOUSE FNP” Practice Location

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