Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 16521 | TN |
NPI | 1003189309 |
---|---|
Provider Name | Mrs. Alisha L Byrd |
First Address | Oneida, TN 37841-6002 |
Second Address | Oneida, TN 37841-6002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2012 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1035I01695 | TN MEDICARE (01) | TN |
6080621 | BCBS TN (01) | TN |