Provider Demographics
NPI:1558305227
Name:DYESS, MARY T (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:T
Last Name:DYESS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:FRANCES
Other - Last Name:TOMPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:120 OMNI DR
Mailing Address - Street 2:CHEER MENTAL HEALTH
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1331
Mailing Address - Country:US
Mailing Address - Phone:931-473-9649
Mailing Address - Fax:931-456-6916
Practice Address - Street 1:120 OMNI DR
Practice Address - Street 2:CHEER MENTAL HEALTH
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1331
Practice Address - Country:US
Practice Address - Phone:931-473-9649
Practice Address - Fax:931-456-6916
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL828652363LP0808X
TNAPN0000015847364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult