Provider Demographics
NPI:1699294595
Name:DONOVAN, CHARLENE L (APRN)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:L
Last Name:DONOVAN
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 1:2102 WOODWIND PT
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4537
Mailing Address - Country:US
Mailing Address - Phone:816-803-8029
Mailing Address - Fax:
Practice Address - Street 1:1283 MURFREESBORO PIKE STE 500
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2421
Practice Address - Country:US
Practice Address - Phone:816-803-8029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN217630163WP0808X
TN23319363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health