Provider Demographics
NPI:1164417127
Name:HESSELRODE, MARK ALLEN (APN)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLEN
Last Name:HESSELRODE
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:993 CORDOVA STATION AVE
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6317
Mailing Address - Country:US
Mailing Address - Phone:901-737-4565
Mailing Address - Fax:901-737-4312
Practice Address - Street 1:993 CORDOVA STATION AVE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6317
Practice Address - Country:US
Practice Address - Phone:901-737-4565
Practice Address - Fax:901-737-4312
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7462363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN208447453Medicare UPIN
TN770626860Medicare UPIN