Provider Demographics
NPI:1538799960
Name:MARTER, ALYSON VICTORIA (MSN, FNP)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:VICTORIA
Last Name:MARTER
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6043 SHALLOWFORD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1653
Mailing Address - Country:US
Mailing Address - Phone:423-802-1919
Mailing Address - Fax:423-269-6178
Practice Address - Street 1:6043 SHALLOWFORD RD STE 101
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1653
Practice Address - Country:US
Practice Address - Phone:423-802-1919
Practice Address - Fax:423-269-6178
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27022207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN27022Medicaid