MEDICARE: KATHRYN MAHONEY HANCOCK 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	39337	TN

General Provider Information

NPI Number	:	1831073857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MAHONEY HANCOCK FNP-BC

Provider Business Mailing Address
First Line	:	76 SUGGS DR
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-7622
Country	:	US
Telephone Number	:	770-845-7446
Fax Number	:

Provider Business Practice Location Address
First Line	:	4998 CROSSINGS CIR STE 100
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-2996
Country	:	US
Telephone Number	:	616-288-4087
Fax Number	:

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

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/25/2025

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