Provider Demographics
NPI:1598098618
Name:COUSINS, MARTHA E (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:E
Last Name:COUSINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:MOHAWK
Mailing Address - State:TN
Mailing Address - Zip Code:37810-5612
Mailing Address - Country:US
Mailing Address - Phone:423-823-0517
Mailing Address - Fax:423-235-3080
Practice Address - Street 1:481 CONCORD RD
Practice Address - Street 2:
Practice Address - City:MOHAWK
Practice Address - State:TN
Practice Address - Zip Code:37810-5612
Practice Address - Country:US
Practice Address - Phone:423-823-0517
Practice Address - Fax:423-235-3080
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14203363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health