Individual
NANCY ANN MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6703 STONE MILL DR, KNOXVILLE, TN 37919-7430
(865) 680-7387
Mailing address
6703 STONE MILL DR, KNOXVILLE, TN 37919-7430
(865) 680-7387
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1802
TN
363AS0400X
Surgical Physician Assistant
PA1802
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1524007
—
TN
Enumeration date
02/18/2010
Last updated
11/04/2020
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