Basic Information
| Provider Information | |||||||||
| NPI: | 1730517079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSLEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SAALE | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 104 WOODMONT BLVD | ||||||||
| Address2: | SUITE LL50 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153862361 | ||||||||
| FaxNumber: | 6153862399 | ||||||||
| Practice Location | |||||||||
| Address1: | 4230 HARDING PIKE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152972700 | ||||||||
| FaxNumber: | 6153862399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2013 | ||||||||
| LastUpdateDate: | 01/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2435 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | Q005307 | 05 | TN | MEDICAID |