Provider Demographics
NPI:1902661119
Name:PRATT, MADISON LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEE
Last Name:PRATT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:LEE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 MORRELL RD APT G105
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5827
Mailing Address - Country:US
Mailing Address - Phone:301-712-5843
Mailing Address - Fax:
Practice Address - Street 1:4629 MILL BRANCH LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37938-3358
Practice Address - Country:US
Practice Address - Phone:301-712-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant