Provider Demographics
NPI:1821829367
Name:EASLEY, ALIYAH RENAE (NP)
Entity type:Individual
Prefix:MRS
First Name:ALIYAH
Middle Name:RENAE
Last Name:EASLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALIYAH
Other - Middle Name:RENAE
Other - Last Name:GIDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1535 FAR DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0609
Mailing Address - Country:US
Mailing Address - Phone:901-500-0838
Mailing Address - Fax:
Practice Address - Street 1:8336 MACON RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8554
Practice Address - Country:US
Practice Address - Phone:901-682-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36723363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty