Basic Information
| Provider Information | |||||||||
| NPI: | 1023116035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENT | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | MOON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, RN, ACNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOON | ||||||||
| OtherFirstName: | MELISSA | ||||||||
| OtherMiddleName: | ROBIN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2400 PATTERSON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153420038 | ||||||||
| FaxNumber: | 6153241752 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 PATTERSON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153420038 | ||||||||
| FaxNumber: | 6153241752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 11/12/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 12565 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.