Provider Demographics
NPI:1013904184
Name:RAWDON, MICHAEL A (FNP MSN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:RAWDON
Suffix:
Gender:M
Credentials:FNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:TN
Mailing Address - Zip Code:38574-1166
Mailing Address - Country:US
Mailing Address - Phone:931-839-2224
Mailing Address - Fax:931-839-2530
Practice Address - Street 1:400 W CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:TN
Practice Address - Zip Code:38574-1166
Practice Address - Country:US
Practice Address - Phone:931-839-2224
Practice Address - Fax:931-839-2530
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3903854Medicaid
TN4267523OtherBCBS
KY7100155710Medicaid
TN103I504649Medicare PIN
S86500Medicare UPIN