Provider Demographics
NPI:1427416379
Name:PEVAHOUSE, TRACY (FNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:PEVAHOUSE
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 1:726 KENTUCKY AVE S
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-3105
Mailing Address - Country:US
Mailing Address - Phone:731-847-6371
Mailing Address - Fax:731-847-2671
Practice Address - Street 1:726 KENTUCKY AVE S
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-3105
Practice Address - Country:US
Practice Address - Phone:731-847-6371
Practice Address - Fax:731-847-2671
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily