Provider Demographics
NPI:1417504010
Name:MCCALL, CORTNI
Entity Type:Individual
Prefix:
First Name:CORTNI
Middle Name:
Last Name:MCCALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 REPUBLICAN GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:38220-4203
Mailing Address - Country:US
Mailing Address - Phone:731-487-2848
Mailing Address - Fax:
Practice Address - Street 1:1250 S MANUFACTURERS ROW
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-3632
Practice Address - Country:US
Practice Address - Phone:731-855-7601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN228171163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health