MEDICARE: MENDY PEVAHOUSE FNP-BC

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	26659	TN
2	363LC1500X	Community Health Nurse Practitioner	26659	TN

General Provider Information

NPI Number	:	1811530454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MENDY PEVAHOUSE FNP-BC

Provider Business Mailing Address
First Line	:	206 CEDAR LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-3507
Country	:	US
Telephone Number	:	865-666-3640
Fax Number	:	865-666-3641

Provider Business Practice Location Address
First Line	:	206 CEDAR LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-3507
Country	:	US
Telephone Number	:	865-666-3640
Fax Number	:	865-666-3641

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

Provider Enumeration Date	:	10/27/2019
Last Update Date	:	07/29/2024

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