Provider Demographics
NPI:1316967144
Name:PEOPLES, SUSAN MIRANDA (FNP MSN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MIRANDA
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:FNP MSN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:HELEN
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN RN FNP
Mailing Address - Street 1:609 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-283-9234
Mailing Address - Fax:423-975-2210
Practice Address - Street 1:219 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2052
Practice Address - Country:US
Practice Address - Phone:423-975-2200
Practice Address - Fax:423-975-2210
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN 0000077907163WG0000X
TNAPN 0000006292363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMP1045637OtherDEA