Active NPI
Tahtionna Brown
- Nurse Practitioner
- Mooresville, NC
National Provider Identifier
1407667322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 5024417
- Practice address
- 417 E Statesville Ave
Mooresville, NC 28115-2590 - Phone
- (704) 663-3063
- NPI assigned
- Jan 20, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 5024417 | NC | Primary |
Addresses
Primary practice location
417 E Statesville Ave
Mooresville, NC 28115-2590
Mailing address
417 E Statesville Ave
Mooresville, NC 28115-2590
Phone (704) 663-3063
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785888000000",
"number": "1407667322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "417 E STATESVILLE AVE",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281152590",
"telephone_number": "704-663-3063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 E STATESVILLE AVE",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281152590",
"telephone_number": "704-663-3063"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "TAHTIONNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-01-20",
"last_updated": "2026-08-05",
"certification_date": "2026-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NC",
"license": "5024417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mooresville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.