Provider Demographics
NPI:1912781261
Name:MCPHERSON, MARY MICHELLE (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MICHELLE
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 OLD BELFAST RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-7138
Mailing Address - Country:US
Mailing Address - Phone:931-580-0879
Mailing Address - Fax:
Practice Address - Street 1:719 THOMPSON LN STE 27100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4684
Practice Address - Country:US
Practice Address - Phone:615-343-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000110525163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant