Healthcare Provider Details

I. General information

NPI: 1598657819
Provider Name (Legal Business Name): BRITTANI NICHOLE MOYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N JACKSON ST
TULLAHOMA TN
37388-2290
US

IV. Provider business mailing address

560 SKYLINE DR S
LEWISBURG TN
37091-3668
US

V. Phone/Fax

Practice location:
  • Phone: 931-910-2249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number35165
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: