Provider Demographics
NPI:1487053815
Name:STORY, MISCHA D (PA)
Entity type:Individual
Prefix:
First Name:MISCHA
Middle Name:D
Last Name:STORY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2011 MURPHY AVE STE 301
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2023
Practice Address - Country:US
Practice Address - Phone:615-327-9543
Practice Address - Fax:615-341-3567
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
TN2830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant