Provider Demographics
NPI:1629590369
Name:MAHAN, MORGAN HOPE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:HOPE
Last Name:MAHAN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HERITAGE SQ
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-2102
Mailing Address - Country:US
Mailing Address - Phone:731-414-4957
Mailing Address - Fax:
Practice Address - Street 1:19 SECURITY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-664-9040
Practice Address - Fax:731-664-9041
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22789363LP2300X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care