Provider Demographics
NPI:1639367741
Name:MOSES, CHARITY A (FNP)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:A
Last Name:MOSES
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 1:4841 HIXSON PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4431
Mailing Address - Country:US
Mailing Address - Phone:423-305-7980
Mailing Address - Fax:423-305-7981
Practice Address - Street 1:4841 HIXSON PIKE STE A
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4431
Practice Address - Country:US
Practice Address - Phone:423-305-7980
Practice Address - Fax:423-305-7981
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12932363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner