Provider Demographics
NPI:1073829180
Name:MOORE, ALISON MONTGOMERY (FNP)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MONTGOMERY
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2231
Mailing Address - Country:US
Mailing Address - Phone:731-989-0001
Mailing Address - Fax:
Practice Address - Street 1:50 SKYLINE LN
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2345
Practice Address - Country:US
Practice Address - Phone:731-847-6373
Practice Address - Fax:731-847-8176
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1523496Medicaid
103I509980Medicare PIN