| Doctor Name: | MR. MIKE J PRIMEAUX |
| NPI Number: | 1003969627 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN-BC |
| License Number: | 12392 |
| Business Practice Address: | 2257 N Germantown Pkwy Suite 112 Cordova, TN - 380167413 |
| Business Phone Number: | 9019225425 |
| Business Fax Number: | 9019225433 |
| Mailing Address: | 2257 N Germantown Pkwy, Suite 112 CORDOVA |
| State: | TN |
| Postal Code: | 380167413 |
| Phone Number: | 9019225425 |
| Fax Number: | |
| NPI Enumeration Date: | 01/18/2007 |
| NPI Last Update Date: | 04/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 12392 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |