Provider Demographics
NPI:1013387349
Name:BYRD, MARY BETH (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:BYRD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1445
Mailing Address - Country:US
Mailing Address - Phone:423-335-3077
Mailing Address - Fax:
Practice Address - Street 1:108 GAY ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1228
Practice Address - Country:US
Practice Address - Phone:423-388-4525
Practice Address - Fax:423-388-4524
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN175773163W00000X
TN20178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse