Provider Demographics
NPI:1467604470
Name:WINFREY, MARY LEANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LEANN
Last Name:WINFREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:291 WHEEL RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-6289
Mailing Address - Country:US
Mailing Address - Phone:931-294-2410
Mailing Address - Fax:
Practice Address - Street 1:3335 HIGHWAY 41A N
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37180-5033
Practice Address - Country:US
Practice Address - Phone:931-294-8464
Practice Address - Fax:931-294-8477
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1666363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical