Provider Demographics
NPI:1124560487
Name:DAY, MIRANDA (NP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:DAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LEE CARTER DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3094
Mailing Address - Country:US
Mailing Address - Phone:865-330-6320
Mailing Address - Fax:865-330-6323
Practice Address - Street 1:818 SUNSET DR
Practice Address - Street 2:STE. 102
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8310
Practice Address - Country:US
Practice Address - Phone:423-794-3142
Practice Address - Fax:865-330-6323
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21145363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4972149OtherCIGNA