Basic Information
| Provider Information | |||||||||
| NPI: | 1134127368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALLER | ||||||||
| FirstName: | AUNA | ||||||||
| MiddleName: | GAE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SEARCY | ||||||||
| OtherFirstName: | AUNA | ||||||||
| OtherMiddleName: | GAE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 640 | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371110640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315071212 | ||||||||
| FaxNumber: | 9315071217 | ||||||||
| Practice Location | |||||||||
| Address1: | 5736 MANCHESTER HWY | ||||||||
| Address2: | |||||||||
| City: | MORRISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373577503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318153871 | ||||||||
| FaxNumber: | 9318153876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 04/22/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | APN5718 | TN | N | Nursing Service Providers | Registered Nurse | General Practice | 207Q00000X | 209004814 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | 5718 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1531083 | 05 | TN | MEDICAID | 11859504 | 01 | CAQH | OTHER |