Provider Demographics
NPI:1427473792
Name:MEAD, STEVEN RAY (NP)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:RAY
Last Name:MEAD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-270-3633
Mailing Address - Fax:931-359-9522
Practice Address - Street 1:1080 N ELLINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2227
Practice Address - Country:US
Practice Address - Phone:931-270-3633
Practice Address - Fax:931-359-9522
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN18423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710089Medicaid
TN3710089Medicaid