Healthcare Provider Details

I. General information

NPI: 1225494206
Provider Name (Legal Business Name): NANCY MOSS CASADAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 E 3RD ST SUITE C-235
CHATTANOOGA TN
37403
US

IV. Provider business mailing address

979 E 3RD ST SUITE C-235
CHATTANOOGA TN
37403-2136
US

V. Phone/Fax

Practice location:
  • Phone: 423-602-8400
  • Fax: 423-602-8401
Mailing address:
  • Phone: 844-468-9496
  • Fax: 855-630-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20802
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: