Healthcare Provider Details

I. General information

NPI: 1275148561
Provider Name (Legal Business Name): SUZANNE D MOYER DNP, AG-ACNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2020
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE STE 365
MEMPHIS TN
38104-7542
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-6030
  • Fax: 901-516-8450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28117
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number28117
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: