Provider Demographics
NPI:1346565009
Name:HAMMONDS, MARY ANN (MSN ADULT NURSE PRA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:HAMMONDS
Suffix:
Gender:F
Credentials:MSN ADULT NURSE PRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 LEISZ RD
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-4327
Mailing Address - Country:US
Mailing Address - Phone:865-394-9078
Mailing Address - Fax:
Practice Address - Street 1:220 FORT SANDERS WEST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3471
Practice Address - Country:US
Practice Address - Phone:865-288-4232
Practice Address - Fax:865-288-4231
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14889363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520176Medicaid
TN1520176Medicaid