Provider Demographics
NPI:1336809987
Name:JOSEY, AUDREY (PA)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:JOSEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:SEAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5038 HUNTER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8316
Mailing Address - Country:US
Mailing Address - Phone:423-910-6100
Mailing Address - Fax:423-910-6109
Practice Address - Street 1:5038 HUNTER RD STE 102
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8316
Practice Address - Country:US
Practice Address - Phone:423-910-6100
Practice Address - Fax:423-910-6109
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPA4888OtherSTATE LICENSE