MEDICARE: ALICIA JILL DUNAWAY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	F05170619	TN
2	363LP2300X	Primary Care Nurse Practitioner	22728	TN

General Provider Information

NPI Number	:	1881123214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA JILL DUNAWAY FNP

Provider Business Mailing Address
First Line	:	8564 REAGAN WOODS LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37931-4480
Country	:	US
Telephone Number	:	423-368-3310
Fax Number	:

Provider Business Practice Location Address
First Line	:	6716 CENTRAL AVENUE PIKE STE 8
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-1425
Country	:	US
Telephone Number	:	865-599-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	07/06/2017

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