Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 26659 | TN |
NPI | 1811530454 |
---|---|
Provider Name | Mendy Pevahouse |
First Address | Knoxville, TN 37902-1215 |
Second Address | Knoxville, TN 37909-2828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2019 |
Last Update Date | 27/10/2019 |