Provider Demographics
NPI:1851568661
Name:MOLDER, AMY LAURA
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LAURA
Last Name:MOLDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 SHELBYVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-6382
Mailing Address - Country:US
Mailing Address - Phone:615-867-8030
Mailing Address - Fax:615-867-8195
Practice Address - Street 1:3626 SHELBYVILLE HWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-6382
Practice Address - Country:US
Practice Address - Phone:615-867-8030
Practice Address - Fax:615-867-8195
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007341363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology