Provider Demographics
NPI:1528719614
Name:PRIORITY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:PRIORITY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNPAPRN,FNP-BC
Authorized Official - Phone:931-302-9564
Mailing Address - Street 1:1912 OLD RUSSELLVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5817
Mailing Address - Country:US
Mailing Address - Phone:931-302-9564
Mailing Address - Fax:844-750-0655
Practice Address - Street 1:1910 S VIRGINIA ST STE 200C
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-6009
Practice Address - Country:US
Practice Address - Phone:270-632-1250
Practice Address - Fax:844-750-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care