Provider Demographics
NPI:1407874860
Name:HARLAN, MARY JANE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:HARLAN
Suffix:
Gender:F
Credentials:FNP
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 316
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-0316
Mailing Address - Country:US
Mailing Address - Phone:865-992-3031
Mailing Address - Fax:865-992-8103
Practice Address - Street 1:6911 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5703
Practice Address - Country:US
Practice Address - Phone:865-992-3031
Practice Address - Fax:865-992-8103
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 6032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3905286Medicaid
TN103I502954OtherMEDICARE
TN3905286Medicare ID - Type Unspecified
TN3905286Medicaid