Provider Demographics
NPI:1497781454
Name:MARTIN, DANA KAY (CFNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:KAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:KAY
Other - Last Name:CHURCHWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PRIME CARE DR
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-1864
Mailing Address - Country:US
Mailing Address - Phone:731-645-7932
Mailing Address - Fax:731-645-5195
Practice Address - Street 1:1 PRIME CARE DR
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-1864
Practice Address - Country:US
Practice Address - Phone:731-645-7932
Practice Address - Fax:731-645-5195
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111819163W00000X
TN7459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908126Medicare ID - Type UnspecifiedHENDERSON
TN3908125Medicare ID - Type UnspecifiedSELMER
TN3908127Medicare ID - Type UnspecifiedADAMSVILLE
500016003Medicare ID - Type UnspecifiedRAILROAD MEDICARE
P16105Medicare UPIN