Individual
ALLISON RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4024 N MOUNT JULIET RD, MOUNT JULIET, TN 37122-3086
(615) 773-9393
(615) 773-9238
Mailing address
4024 N MOUNT JULIET RD, MOUNT JULIET, TN 37122-3086
(615) 773-9393
(615) 773-9238
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
720
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
720
STATE LICENSE
TN
Enumeration date
08/05/2006
Last updated
07/08/2007
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