Healthcare Provider Details

I. General information

NPI: 1417517830
Provider Name (Legal Business Name): TIFFANY ALYSSA ROULIER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 DAVIS ST
MERIDIAN MS
39301
US

IV. Provider business mailing address

350 N HUMPHREYS BLVD
MEMPHIS TN
38120-2177
US

V. Phone/Fax

Practice location:
  • Phone: 601-693-0118
  • Fax: 844-778-8922
Mailing address:
  • Phone: 901-226-4003
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903395
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: