Healthcare Provider Details

I. General information

NPI: 1023943024
Provider Name (Legal Business Name): ALLYSON AVERETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BLACKFORD ST
CHATTANOOGA TN
37403-1405
US

IV. Provider business mailing address

725 CREEKSIDE DR
SANFORD NC
27330-9681
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-6011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number359816
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: