Provider Demographics
NPI:1144829839
Name:MCINNIS, DOUGLAS ARTHUR JR (FNP)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ARTHUR
Last Name:MCINNIS
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:615-284-4029
Mailing Address - Fax:629-802-9993
Practice Address - Street 1:1911 STATE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2209
Practice Address - Country:US
Practice Address - Phone:615-284-2015
Practice Address - Fax:615-284-2005
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000028235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner