Doctor Name: | ALLISON RUSSELL |
NPI Number: | 1144239658 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | 720 |
Business Practice Address: | 4024 N Mount Juliet Rd Mount Juliet, TN - 371223086 |
Business Phone Number: | 6157739393 |
Business Fax Number: | 6157739238 |
Mailing Address: | 4024 N Mount Juliet Rd, MOUNT JULIET |
State: | TN |
Postal Code: | 371223086 |
Phone Number: | 6157739393 |
Fax Number: | 6157739238 |
NPI Enumeration Date: | 08/05/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 720 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |