Provider Demographics
NPI:1225592744
Name:SELVAGE, DAWN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:SELVAGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-0480
Mailing Address - Country:US
Mailing Address - Phone:931-800-4622
Mailing Address - Fax:931-952-6600
Practice Address - Street 1:1019 HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2029
Practice Address - Country:US
Practice Address - Phone:931-800-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily