Provider Demographics
NPI:1184242638
Name:MATHENEY, MISTY LEE (CPRS)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:LEE
Last Name:MATHENEY
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 WREN RD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2316
Mailing Address - Country:US
Mailing Address - Phone:615-766-8081
Mailing Address - Fax:615-766-8083
Practice Address - Street 1:839 WREN RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2316
Practice Address - Country:US
Practice Address - Phone:615-766-8081
Practice Address - Fax:615-766-8083
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000-1261175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist