Provider Demographics
NPI:1548247885
Name:MOULD, STEPHEN J (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:MOULD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:615-329-2294
Mailing Address - Fax:615-695-1494
Practice Address - Street 1:1800 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:615-896-6800
Practice Address - Fax:615-695-1483
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2682363AM0700X, 363AS0400X
TN2862363A00000X
TNPA2682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ010356Medicaid
NC2752530Medicare ID - Type Unspecified
NCP14282Medicare UPIN