Provider Demographics
NPI:1053788497
Name:VEST, MITCHELL (HIS)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:VEST
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 CENTRAL PIKE STE 355
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3422
Mailing Address - Country:US
Mailing Address - Phone:615-889-4105
Mailing Address - Fax:
Practice Address - Street 1:3901 CENTRAL PIKE STE 355
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3422
Practice Address - Country:US
Practice Address - Phone:615-889-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN809237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist