Provider Demographics
NPI:1790797595
Name:DYSON, JO ELLYN (PA-C)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ELLYN
Last Name:DYSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COOL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2677
Mailing Address - Country:US
Mailing Address - Phone:615-771-7546
Mailing Address - Fax:615-771-8600
Practice Address - Street 1:200 COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2677
Practice Address - Country:US
Practice Address - Phone:615-771-7546
Practice Address - Fax:615-771-8600
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000583363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant