Healthcare Provider Details

I. General information

NPI: 1881204501
Provider Name (Legal Business Name): CARRIE ANN MOFIELD MSN,ARNP,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 GLENWOOD DR STE E780
CHATTANOOGA TN
37404-1177
US

IV. Provider business mailing address

8066 CHESHIRE LN
CHATTANOOGA TN
37421-1110
US

V. Phone/Fax

Practice location:
  • Phone: 423-697-0072
  • Fax:
Mailing address:
  • Phone: 740-506-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33533
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07201077
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: