Provider Demographics
NPI:1073778007
Name:MCCLUSKEY, DENISE RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:FNP-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:423-458-6267
Mailing Address - Fax:423-790-7136
Practice Address - Street 1:6784 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307-4818
Practice Address - Country:US
Practice Address - Phone:423-338-2831
Practice Address - Fax:423-338-2833
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN18178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007019Medicaid
TNQ007019Medicaid