# FULL MOON PSYCHIATRIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255908026
- **Authorized official:** ALECIA WHITE NP (OWNER/OPERATOR)
- **Authorized official phone:** (931) 371-7125

## Contact information

- **Practice address:** 5810 SHELBY OAKS DR STE B, MEMPHIS, TN 38134-7315
- **Practice address phone:** (931) 371-7125
- **Mailing address:** 2033 FORT CAMPBELL BLVD, STE A PMB 1071, CLARKSVILLE, TN 37042

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/09/2021
- **Last updated:** 06/14/2021