Healthcare Provider Details

I. General information

NPI: 1609643246
Provider Name (Legal Business Name): MISS ALYSSIA EASLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E MAIN ST
MURFREESBORO TN
37132-0002
US

IV. Provider business mailing address

1301 E MAIN ST
MURFREESBORO TN
37132-0002
US

V. Phone/Fax

Practice location:
  • Phone: 615-898-4744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: