Provider Demographics
NPI:1285246389
Name:DUDLEY, ANDREW STEPHENS
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEPHENS
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 EASTLAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-1705
Mailing Address - Country:US
Mailing Address - Phone:615-638-9250
Mailing Address - Fax:618-822-4082
Practice Address - Street 1:2002 EASTLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-1705
Practice Address - Country:US
Practice Address - Phone:615-638-9250
Practice Address - Fax:618-822-4082
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN240649163W00000X
TN28130363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse