Provider Demographics
NPI:1154786937
Name:OOSTHUYSEN, MOLLY (FNP-BC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:OOSTHUYSEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 HAYES LN
Mailing Address - Street 2:
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-2025
Mailing Address - Country:US
Mailing Address - Phone:937-830-5369
Mailing Address - Fax:
Practice Address - Street 1:1346 DOWELL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2453
Practice Address - Country:US
Practice Address - Phone:865-588-2753
Practice Address - Fax:865-588-7418
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF1015311363LF0000X
OHF1015311363LF0000X
TNAPN0000032244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily