Provider Demographics
NPI:1780710574
Name:MULLOY, MARY KATHERINE (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:MULLOY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 CRESTMOOR RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2027
Mailing Address - Country:US
Mailing Address - Phone:615-324-3461
Mailing Address - Fax:615-297-4659
Practice Address - Street 1:2325 CRESTMOOR RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2027
Practice Address - Country:US
Practice Address - Phone:615-324-3461
Practice Address - Fax:615-297-4659
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005615363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341764Medicaid
TN5615OtherAPN LICENSE
TN3341764Medicaid
TN5615OtherAPN LICENSE