Provider Demographics
NPI:1548275274
Name:GEMMILL, STEVEN JOSEPH (APRN, BC,CS,NP,LADAC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:GEMMILL
Suffix:
Gender:M
Credentials:APRN, BC,CS,NP,LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 TIMBER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4233
Mailing Address - Country:US
Mailing Address - Phone:901-566-1002
Mailing Address - Fax:
Practice Address - Street 1:8130 COUNTRY VILLAGE DR STE 102
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2087
Practice Address - Country:US
Practice Address - Phone:901-308-2915
Practice Address - Fax:901-308-2924
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006820364SP0809X
TN6820363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000656Medicaid
TNQ000656Medicaid
TN3344488Medicaid