Provider Demographics
NPI:1659788750
Name:PAFFORD, MAGNOLIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MAGNOLIA
Middle Name:
Last Name:PAFFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-3327
Mailing Address - Country:US
Mailing Address - Phone:931-589-2222
Mailing Address - Fax:
Practice Address - Street 1:62 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-3327
Practice Address - Country:US
Practice Address - Phone:931-589-2222
Practice Address - Fax:931-589-2400
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007529Medicaid