Provider Demographics
NPI:1053610121
Name:USSERY, MARTHA JANE (BS)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JANE
Last Name:USSERY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:JANE
Other - Last Name:SHIPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1090 OLD FLORENCE ROAD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-8401
Mailing Address - Country:US
Mailing Address - Phone:931-762-6505
Mailing Address - Fax:931-762-3690
Practice Address - Street 1:1090 OLD FLORENCE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-8401
Practice Address - Country:US
Practice Address - Phone:931-762-6505
Practice Address - Fax:931-762-3690
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator