Provider Demographics
NPI:1548599608
Name:HULL, CHADRICK LEON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHADRICK
Middle Name:LEON
Last Name:HULL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 S WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-8495
Mailing Address - Country:US
Mailing Address - Phone:931-484-5379
Mailing Address - Fax:931-484-5946
Practice Address - Street 1:131 S WEBB AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-8495
Practice Address - Country:US
Practice Address - Phone:931-484-5379
Practice Address - Fax:931-484-5946
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1825363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical