Provider Demographics
NPI:1811530454
Name:PEVAHOUSE, MENDY (FNP-BC)
Entity type:Individual
Prefix:
First Name:MENDY
Middle Name:
Last Name:PEVAHOUSE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-3507
Mailing Address - Country:US
Mailing Address - Phone:865-666-3640
Mailing Address - Fax:865-666-3641
Practice Address - Street 1:206 CEDAR LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-3507
Practice Address - Country:US
Practice Address - Phone:865-666-3640
Practice Address - Fax:865-666-3641
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26659363LF0000X, 363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty