Healthcare Provider Details

I. General information

NPI: 1073829180
Provider Name (Legal Business Name): ALISON MONTGOMERY MOORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SKYLINE LN
PARSONS TN
38363-2345
US

IV. Provider business mailing address

116 W MAIN ST
HENDERSON TN
38340-2231
US

V. Phone/Fax

Practice location:
  • Phone: 731-847-6373
  • Fax: 731-847-8176
Mailing address:
  • Phone: 731-989-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15055
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: