Provider Demographics
NPI:1386281384
Name:KONG-MEAN, PAULINE S (APRN)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:S
Last Name:KONG-MEAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:629-208-6200
Mailing Address - Fax:629-208-6201
Practice Address - Street 1:3754 MURFREESBORO PIKE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3878
Practice Address - Country:US
Practice Address - Phone:629-208-6200
Practice Address - Fax:629-208-6201
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily