Provider Demographics
NPI:1447794201
Name:MANN, MARY JO (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:MANN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 LA PALOMA DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-1418
Mailing Address - Country:US
Mailing Address - Phone:865-621-7220
Mailing Address - Fax:
Practice Address - Street 1:9137 MIDDLEBROOK PIKE
Practice Address - Street 2:CVS # 4624
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-1425
Practice Address - Country:US
Practice Address - Phone:865-670-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily