Pettigrew, Madison D

Pettigrew, Madison D is an sole proprietor health care provider with primary practice located at 8130 Country Village Dr Ste 103 , Cordova TN 38016-2087. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is his primary health care specialty. Pettigrew, Madison D can be contacted via phone (901) 308-2915.

Contact Information

Primary practice address
8130 Country Village Dr Ste 103 Cordova TN 38016-2087
Phone: (901) 308-2915
Fax: (901) 308-2924
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 171949 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 904213 Mississippi
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 28484 Tennessee

Profile Details

NPI number 1912211764
LBN Legal business name Pettigrew, Madison D
Credentials MSN, APN, PMHNP-BC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 4th, 2010
Last updated Aug 1st, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912211764 NPPES
Tennessee MEDICAID T24221A
Tennessee Other 1I5219

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