Provider Demographics
NPI:1649579319
Name:DUFF, MARY BETH (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:DUFF
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP-BC
Mailing Address - Street 1:927 N JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2753
Mailing Address - Country:US
Mailing Address - Phone:931-375-1132
Mailing Address - Fax:615-367-1445
Practice Address - Street 1:927 N JAMES CAMPBELL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2753
Practice Address - Country:US
Practice Address - Phone:931-375-1132
Practice Address - Fax:615-367-1445
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily