Provider Demographics
NPI:1891701017
Name:HUGHEY, MARISA S (NP)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:S
Last Name:HUGHEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:SUMMER
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:845 JACK RUDOLPH LN
Mailing Address - Street 2:
Mailing Address - City:HURRICANE MILLS
Mailing Address - State:TN
Mailing Address - Zip Code:37078-2230
Mailing Address - Country:US
Mailing Address - Phone:615-483-3927
Mailing Address - Fax:
Practice Address - Street 1:9019 OVERLOOK BLVD STE C1B
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2737
Practice Address - Country:US
Practice Address - Phone:615-274-9767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN137399363L00000X
TN8343363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506648Medicaid
TN1506648Medicaid
TN10350I7093Medicare PIN