Provider Demographics
NPI:1215580824
Name:MORELAND, DANA PHILLIPS (FNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:PHILLIPS
Last Name:MORELAND
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 1:420 W MORRIS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2255
Mailing Address - Country:US
Mailing Address - Phone:423-581-3939
Mailing Address - Fax:
Practice Address - Street 1:420 W MORRIS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2255
Practice Address - Country:US
Practice Address - Phone:423-581-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017029363LF0000X
TNAPN26225363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily