Individual
PRISCILLA SIOSON-AHERRERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-6472
Mailing address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-6472
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
19247
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3050460
—
TN
05
—
3050461
—
TN
01
—
4055519
BCBS
—
01
—
440003621
RR MEDICARE
—
Enumeration date
07/12/2006
Last updated
02/09/2010
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