Provider Demographics
NPI:1689399982
Name:GENTRY, MARQURELL MARVA (PMHNP)
Entity Type:Individual
Prefix:
First Name:MARQURELL
Middle Name:MARVA
Last Name:GENTRY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 BENJAMIN DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-8544
Mailing Address - Country:US
Mailing Address - Phone:131-479-2876
Mailing Address - Fax:
Practice Address - Street 1:1707 BENJAMIN DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-8544
Practice Address - Country:US
Practice Address - Phone:131-479-2876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32716363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health