Provider Demographics
NPI:1841079373
Name:MASON, MADALYN NICOLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MADALYN
Middle Name:NICOLE
Last Name:MASON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:MADALYN
Other - Middle Name:NICOLE
Other - Last Name:BOROUGHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:304 E LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-2626
Mailing Address - Country:US
Mailing Address - Phone:901-674-5697
Mailing Address - Fax:
Practice Address - Street 1:1995 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3635
Practice Address - Country:US
Practice Address - Phone:901-475-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty