Healthcare Provider Details

I. General information

NPI: 1679603310
Provider Name (Legal Business Name): TIMOTHY K MOSS A.P.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 COLUMBIA AVE
FRANKLIN TN
37064-3921
US

IV. Provider business mailing address

1915 COLUMBIA AVE
FRANKLIN TN
37064-3921
US

V. Phone/Fax

Practice location:
  • Phone: 615-794-9973
  • Fax: 615-794-9961
Mailing address:
  • Phone: 615-794-9973
  • Fax: 615-794-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000143944
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN0000010677
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: