Provider Demographics
NPI:1851531164
Name:VESCOVO, MARY KATHRYN (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHRYN
Last Name:VESCOVO
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:2595 CENTRAL AVENUE
Mailing Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-260-8500
Mailing Address - Fax:901-260-8590
Practice Address - Street 1:3362 S. THIRD STREET
Practice Address - Street 2:CHRIST COMMUNITY HEALTH SERVICE INC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109
Practice Address - Country:US
Practice Address - Phone:901-271-6300
Practice Address - Fax:901-260-8590
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2011-01-20
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Provider Licenses
StateLicense IDTaxonomies
TN14448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512954Medicaid