Provider Demographics
NPI:1265418966
Name:FADDEN, MARY KAY (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:FADDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 W DUE WEST AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4423
Mailing Address - Country:US
Mailing Address - Phone:615-425-3333
Mailing Address - Fax:615-425-3348
Practice Address - Street 1:617 S 8TH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3819
Practice Address - Country:US
Practice Address - Phone:615-228-8902
Practice Address - Fax:615-226-2679
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNPA0000001679363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant