Provider Demographics
NPI:1043375827
Name:NASERI, MOUSA K (FNP)
Entity type:Individual
Prefix:DR
First Name:MOUSA
Middle Name:K
Last Name:NASERI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:533 BIG LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:TN
Mailing Address - Zip Code:37681-2537
Mailing Address - Country:US
Mailing Address - Phone:423-257-8382
Mailing Address - Fax:423-257-8380
Practice Address - Street 1:533 BIG LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:LIMESTONE
Practice Address - State:TN
Practice Address - Zip Code:37681-2537
Practice Address - Country:US
Practice Address - Phone:423-257-8382
Practice Address - Fax:423-257-8380
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS60041Medicare UPIN
TN103I501373Medicare PIN