Provider Demographics
NPI:1174549638
Name:PASCARELLA, MARTHA JEAN (NP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JEAN
Last Name:PASCARELLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-0906
Mailing Address - Country:US
Mailing Address - Phone:423-745-1277
Mailing Address - Fax:423-745-2188
Practice Address - Street 1:719 COOK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3495
Practice Address - Country:US
Practice Address - Phone:423-745-1277
Practice Address - Fax:423-745-2188
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000087737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4020106OtherBCBS
TN500021758OtherMEDICARE RR
TN4020106OtherBCBS
TNS26362Medicare UPIN