1558305227 NPI number — MRS. MARY T DYESS APRN

Table of content: MRS. MARY T DYESS APRN (NPI 1558305227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558305227 NPI number — MRS. MARY T DYESS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DYESS
Provider First Name:
MARY
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOMPKINS
Provider Other First Name:
MARY
Provider Other Middle Name:
FRANCES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558305227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 OMNI DR
Provider Second Line Business Mailing Address:
CHEER MENTAL HEALTH
Provider Business Mailing Address City Name:
MCMINNVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37110-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-473-9649
Provider Business Mailing Address Fax Number:
931-456-6916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 OMNI DR
Provider Second Line Business Practice Location Address:
CHEER MENTAL HEALTH
Provider Business Practice Location Address City Name:
MCMINNVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37110-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-473-9649
Provider Business Practice Location Address Fax Number:
931-456-6916
Provider Enumeration Date:
06/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  828652 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SP0809X , with the licence number: APN0000015847 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)