1891701017 NPI number — MARISA S HUGHEY NP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891701017 NPI number — MARISA S HUGHEY NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUGHEY
Provider First Name:
MARISA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IRWIN
Provider Other First Name:
MARISA
Provider Other Middle Name:
SUMMER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891701017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 22ND AVE N
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-284-2222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5653 FRIST BLVD
Provider Second Line Business Practice Location Address:
SUITE 630
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37076-2062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-391-3971
Provider Business Practice Location Address Fax Number:
615-391-4725
Provider Enumeration Date:
07/31/2006

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: 363L00000X , with the licence number:  137399 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1506648 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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