Provider Demographics
NPI:1720626591
Name:JOSEPH, MATTIE (NP)
Entity Type:Individual
Prefix:
First Name:MATTIE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MATTIE
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1176 POOLE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPMANSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37035-5327
Mailing Address - Country:US
Mailing Address - Phone:615-319-5051
Mailing Address - Fax:
Practice Address - Street 1:6294 HIGHWAY 41A
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-8175
Practice Address - Country:US
Practice Address - Phone:615-746-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily