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Individual

JO SUSAN OFFUTT-BLACKABY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, PMHNP

Contact information

Practice address
2006 MAGGIE CT, GREENBRIER, TN 37073-0500
(615) 620-0998
Mailing address
2006 MAGGIE CT, GREENBRIER, TN 37073-0500
(615) 970-9467
(615) 246-9030

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
19574
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
25460
SC
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
19574
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3335
MEDICARE
SC
05
421504
SC
Enumeration date
01/13/2015
Last updated
01/04/2024
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