Provider Demographics
NPI:1881150746
Name:MOON, JENNIFER (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 DEERPATH DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:TN
Mailing Address - Zip Code:37037-6135
Mailing Address - Country:US
Mailing Address - Phone:615-995-0066
Mailing Address - Fax:
Practice Address - Street 1:1009 N THOMPSON LN
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4351
Practice Address - Country:US
Practice Address - Phone:615-867-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25424363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health