Healthcare Provider Details

I. General information

NPI: 1750784526
Provider Name (Legal Business Name): MOUNA YUSSUF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 COLUMBIA PIKE
THOMPSONS STATION TN
37179-5207
US

IV. Provider business mailing address

4805 COLUMBIA PIKE
THOMPSONS STATION TN
37179-5207
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-216-3854
Mailing address:
  • Phone: 866-389-2727
  • Fax: 401-216-3854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19226
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19226
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: