Basic Information
| Provider Information | |||||||||
| NPI: | 1881150746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOON | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2632 DEERPATH DR | ||||||||
| Address2: | |||||||||
| City: | CHRISTIANA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370376135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159950066 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1009 N THOMPSON LN | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371294351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158671111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2019 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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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 | 363LP0808X | 25424 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.