Provider Demographics
NPI:1508631599
Name:MENGISTU, BISRAT MICAEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:BISRAT
Middle Name:MICAEL
Last Name:MENGISTU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5544 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2576
Mailing Address - Country:US
Mailing Address - Phone:615-515-0029
Mailing Address - Fax:
Practice Address - Street 1:5544 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2576
Practice Address - Country:US
Practice Address - Phone:615-515-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily