Healthcare Provider Details

I. General information

NPI: 1427696582
Provider Name (Legal Business Name): ALLIE BOYD SEATON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 HIGHWAY 45 BYP S
MEDINA TN
38355-9633
US

IV. Provider business mailing address

46 GREY BARK CV
JACKSON TN
38305-3843
US

V. Phone/Fax

Practice location:
  • Phone: 731-462-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4165
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: