Individual
SELENA RENEE PEVAHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 MILLER DRIVE, CLIFTON, TN 38425
(731) 607-1007
Mailing address
PO BOX 54, CLIFTON, TN 38425-0054
(731) 607-1007
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26817
TN
Other
Enumeration date
01/07/2020
Last updated
01/07/2020
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