Provider Demographics
NPI:1609016005
Name:PHILLIPS, MARY E (APN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 CUMBERLAND BND
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1805
Mailing Address - Country:US
Mailing Address - Phone:615-726-3340
Mailing Address - Fax:615-726-1502
Practice Address - Street 1:105 1/2 MATHIS DR
Practice Address - Street 2:SUITE D
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2096
Practice Address - Country:US
Practice Address - Phone:615-446-3061
Practice Address - Fax:615-446-9567
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN14012363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health