Provider Demographics
NPI:1538671987
Name:CLAIBORNE, MARY ANNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:CLAIBORNE
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 1:420 COLLEGE ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1751
Mailing Address - Country:US
Mailing Address - Phone:615-688-5383
Mailing Address - Fax:888-972-5790
Practice Address - Street 1:420 COLLEGE ST STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1751
Practice Address - Country:US
Practice Address - Phone:615-688-5383
Practice Address - Fax:888-972-5790
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ038634Medicaid