Provider Demographics
NPI:1669647756
Name:WEBB, ALICIA ROSE (PNP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ROSE
Last Name:WEBB
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Gender:F
Credentials:PNP
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Mailing Address - Street 1:1335 ROCK SPRINGS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6108
Mailing Address - Country:US
Mailing Address - Phone:615-459-5252
Mailing Address - Fax:615-550-5226
Practice Address - Street 1:990 ELLISTON WAY, SUITE 100
Practice Address - Street 2:GRACE PEDIATRICS, PLLC
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179
Practice Address - Country:US
Practice Address - Phone:615-550-5221
Practice Address - Fax:615-550-5226
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2017-02-24
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012304363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000167Medicaid