Healthcare Provider Details

I. General information

NPI: 1043375827
Provider Name (Legal Business Name): MOUSA K NASERI FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 BIG LIMESTONE RD
LIMESTONE TN
37681-2537
US

IV. Provider business mailing address

533 BIG LIMESTONE RD
LIMESTONE TN
37681-2537
US

V. Phone/Fax

Practice location:
  • Phone: 423-257-8382
  • Fax: 423-257-8380
Mailing address:
  • Phone: 423-257-8382
  • Fax: 423-257-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN6456
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: