Provider Demographics
NPI:1386699361
Name:RHOADS, MARY SUE (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:RHOADS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:MICHIE
Mailing Address - State:TN
Mailing Address - Zip Code:38357-0297
Mailing Address - Country:US
Mailing Address - Phone:731-632-1783
Mailing Address - Fax:731-632-1786
Practice Address - Street 1:6659 MICHIE PEBBLE HILL RD
Practice Address - Street 2:
Practice Address - City:MICHIE
Practice Address - State:TN
Practice Address - Zip Code:38357-5115
Practice Address - Country:US
Practice Address - Phone:731-632-1783
Practice Address - Fax:731-632-1786
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4019606OtherBCBS
TN3730834Medicaid
TN3730834Medicare ID - Type Unspecified
TN3730834Medicaid