Mickie Cody

Individual provider Active NPI Licensed Practical Nurse · Talbott, TN

NPI 1083175632 · NPPES record last updated Mar 27, 2019

Key facts

NPI
1083175632
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
75643 (TN)
Practice address
6350 W Andrew Johnson Hwy
Talbott, TN 37877-8605
Phone
(423) 587-7337
Fax
(423) 586-0614
NPI assigned
Mar 27, 2019
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
75643TNMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 75643 TN Yes

Addresses

Primary practice location

6350 W Andrew Johnson Hwy
Talbott, TN 37877-8605

Mailing address

1923 Sulphur Springs Rd
Morristown, TN 37813-5654
Phone (423) 317-9344

Other providers in Talbott, TN

All providers in Talbott, TN · Licensed Practical Nurse in Tennessee

Sources for this page

Verify at the official NPI Registry.