1417981523 NPI number — MRS. MOLLY BORING APRN, BC

Table of content: MRS. MOLLY BORING APRN, BC (NPI 1417981523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417981523 NPI number — MRS. MOLLY BORING APRN, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORING
Provider First Name:
MOLLY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417981523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 GLIDEPATH WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37090-4133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-449-5771
Provider Business Mailing Address Fax Number:
615-449-5740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3786 CENTRAL PIKE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37076-3498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-964-5941
Provider Business Practice Location Address Fax Number:
615-964-5948
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APN0000007619 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3026483 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3043372 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".