Provider Demographics
NPI:1053735696
Name:DENNIS, DOMINIQUE (FNP)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:615-824-3737
Mailing Address - Fax:855-540-4722
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 250
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-824-3737
Practice Address - Fax:855-540-4722
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17624363LF0000X
TNAPN17824208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100296020Medicaid
TNQ007179Medicaid
TN6021198OtherBCBS OF TN
KY7100296020Medicaid