Provider Demographics
NPI:1265455091
Name:MOLETTE, ANNA-LOUISE O (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA-LOUISE
Middle Name:O
Last Name:MOLETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 DEER PARK DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-3319
Mailing Address - Country:US
Mailing Address - Phone:615-294-8829
Mailing Address - Fax:
Practice Address - Street 1:739 PRESIDENT PL
Practice Address - Street 2:SUITE 220
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6844
Practice Address - Country:US
Practice Address - Phone:615-459-3244
Practice Address - Fax:615-459-6525
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34231174400000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3856866Medicaid
TNH23853Medicare UPIN
TN3856866Medicaid