Provider Demographics
NPI:1356684369
Name:MOSES, JAMIE H (APN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:H
Last Name:MOSES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 BRAINERD RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5310
Mailing Address - Country:US
Mailing Address - Phone:423-265-3561
Mailing Address - Fax:423-265-1364
Practice Address - Street 1:5616 BRAINERD RD
Practice Address - Street 2:SUITE 208
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5310
Practice Address - Country:US
Practice Address - Phone:423-265-3561
Practice Address - Fax:423-265-1364
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ023410Medicaid