Provider Demographics
NPI:1013101807
Name:DAILEY, MISTY L (RN, FNP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:L
Last Name:DAILEY
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 E BADDOUR PKWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3254
Mailing Address - Country:US
Mailing Address - Phone:615-444-5325
Mailing Address - Fax:615-443-6402
Practice Address - Street 1:927 EAST BADDOUR PARKWAY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3254
Practice Address - Country:US
Practice Address - Phone:615-444-5325
Practice Address - Fax:615-443-6402
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN129517163W00000X
TN12863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse