Provider Demographics
NPI:1043392715
Name:OGDEN, MARY ELAINE (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:OGDEN
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 1:2300 B EAST THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2700
Mailing Address - Country:US
Mailing Address - Phone:423-702-7900
Mailing Address - Fax:423-702-7905
Practice Address - Street 1:251 N LYERLY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2743
Practice Address - Country:US
Practice Address - Phone:423-826-8000
Practice Address - Fax:423-826-8005
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8110OtherAPN LICENSE
TN1524680Medicaid
TN129011OtherRN LICENSE
TN1524680Medicaid