Provider Demographics
NPI:1740622281
Name:MCCONNELL-CARMONY, ALESHA CARROLL (PA)
Entity type:Individual
Prefix:
First Name:ALESHA
Middle Name:CARROLL
Last Name:MCCONNELL-CARMONY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-1010
Mailing Address - Country:US
Mailing Address - Phone:865-365-4015
Mailing Address - Fax:865-299-5025
Practice Address - Street 1:849 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4928
Practice Address - Country:US
Practice Address - Phone:865-365-4015
Practice Address - Fax:866-299-5025
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant