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General NPI Number Information
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NPI Number | 1417517830
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Entity Type | Individual
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Provider Name | TIFFANY ALYSSA ROULIER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 2701 DAVIS ST
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City | MERIDIAN
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State | MS
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Zip | 39301
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Country | US
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Telephone | 601-693-0118
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Fax | 844-778-8922
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Provider Business Mailing Address
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Address Line | 350 N HUMPHREYS BLVD
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City | MEMPHIS
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State | TN
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Zip | 38120-2177
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Country | US
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Telephone | 901-226-4003
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Fax | 901-227-8591
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 903395
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License Number State | MS
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