Provider Demographics
NPI:1639469539
Name:MOSS, LAUREN BERNICE (WHNP-BC, ANP-BC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BERNICE
Last Name:MOSS
Suffix:
Gender:F
Credentials:WHNP-BC, ANP-BC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:AHIATSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAUREN AHIATSI
Mailing Address - Street 1:1701 LIBERTY PIKE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5899
Mailing Address - Country:US
Mailing Address - Phone:615-347-8949
Mailing Address - Fax:
Practice Address - Street 1:930 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-3644
Practice Address - Country:US
Practice Address - Phone:615-471-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000015786363LW0102X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health