Healthcare Provider Details

I. General information

NPI: 1134464449
Provider Name (Legal Business Name): MRS. PATRICIA MOYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W MAIN ST
MORRISTOWN TN
37814-4621
US

IV. Provider business mailing address

PO BOX 59019
KNOXVILLE TN
37950-9019
US

V. Phone/Fax

Practice location:
  • Phone: 423-586-6431
  • Fax:
Mailing address:
  • Phone: 423-586-6431
  • Fax: 423-586-6324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: