Provider Demographics
NPI:1144409566
Name:MANESS, JOSEPH HENRY (NP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HENRY
Last Name:MANESS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4977 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-4127
Mailing Address - Country:US
Mailing Address - Phone:615-288-4470
Mailing Address - Fax:615-288-4541
Practice Address - Street 1:4977 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-4127
Practice Address - Country:US
Practice Address - Phone:615-288-4470
Practice Address - Fax:615-288-4541
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR874581163W00000X, 363LF0000X
TNAPN0000006366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3929117Medicaid
TN3929117Medicare PIN