Healthcare Provider Details

I. General information

NPI: 1831846344
Provider Name (Legal Business Name): ALYSHA MARIE SALAS CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 W BROADWAY AVE STE. 1
MARYVILLE TN
37801
US

IV. Provider business mailing address

1135 HAVENWOOD DR
MARYVILLE TN
37804-3105
US

V. Phone/Fax

Practice location:
  • Phone: 865-724-8644
  • Fax: 865-381-4868
Mailing address:
  • Phone: 865-724-8644
  • Fax: 865-381-4868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number109
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: