| NPI |
1104523703 |
The State code in the location of the provider
being identified. |
| Entity Type Code |
1 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Last Name Legal Name |
WEST |
The country code in the location address of the provider being identified. |
| Provider First Name |
ALLEE |
The telephone number associated with the location address of the provider being identified. |
| Provider First Line Business Practice Location Address |
310 W 3RD NORTH ST |
The fax number associated with the location
address of the provider being identified. |
| Provider Business Practice Location Address City Name |
MORRISTOWN |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Provider Business Practice Location Address State Name |
TN |
The date that a record was last updated or changed. |
| Provider Business Practice Location Address Postal Code |
378144038 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The first name of the authorized official. |
| Provider Business Practice Location Address Telephone Number |
4233527982 |
The telephone number associated with the location address of the provider being identified. |
| Provider Enumeration Date |
2/14/2023 |
The 10-position telephone number of the authorized official. |
| Last Update Date |
2/14/2023 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider Gender Code |
F |
|
| Healthcare Provider Taxonomy Code 1 |
171M00000X |
|
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| NPI Certification Date |
2/14/2023 |
|