Individual
MAYLEE GRACE MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
739 BLUFF CITY HWY STE 3, BRISTOL, TN 37620-4637
(423) 534-9195
Mailing address
926 W OAKLAND AVE STE 202, JOHNSON CITY, TN 37604-1445
(423) 850-1150
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0000245367
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
0024192489
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
34099
TN
Other
Enumeration date
05/17/2023
Last updated
03/13/2025
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