Healthcare Provider Details

I. General information

NPI: 1528662517
Provider Name (Legal Business Name): ALISON MILLER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALI JORDAN PMHNP

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 TYSON AVE
PARIS TN
38242-4544
US

IV. Provider business mailing address

441 S POINT DR
CAMDEN TN
38320-7839
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-1220
  • Fax: 731-644-8424
Mailing address:
  • Phone: 731-441-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28608
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: