Provider Demographics
NPI:1336519925
Name:MUKATIRA, UTHAPPA (PHD, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:UTHAPPA
Middle Name:
Last Name:MUKATIRA
Suffix:
Gender:M
Credentials:PHD, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8546
Mailing Address - Country:US
Mailing Address - Phone:901-755-1396
Mailing Address - Fax:
Practice Address - Street 1:1088 ROGERS RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8546
Practice Address - Country:US
Practice Address - Phone:901-755-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20502363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health