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General NPI Number Information
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NPI Number | 1639652498
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Entity Type | Individual
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Provider Name | TRACY M MOSEMAN FNP
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Gender | Female
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 1450 DOWELL SPRINGS BLVD STE 300
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City | KNOXVILLE
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State | TN
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Zip | 37909-2444
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Country | US
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Telephone | 865-637-8812
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Fax | 865-637-8865
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Provider Business Mailing Address
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Address Line | 8320 MADISON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-6066
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Country | US
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Telephone | 317-882-5122
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Fax |
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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 | 32575
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71008310A
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License Number State | IN
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