Basic Information
| Provider Information | |||||||||
| NPI: | 1265455091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLETTE | ||||||||
| FirstName: | ANNA-LOUISE | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 DEER PARK DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372053319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152948829 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 739 PRESIDENT PL | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154593244 | ||||||||
| FaxNumber: | 6154596525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD34231 | TN | N | Other Service Providers | Specialist | 2081P2900X | MD34231 | TN | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3856866 | 05 | TN | MEDICAID |