Healthcare Provider Details

I. General information

NPI: 1437462033
Provider Name (Legal Business Name): FREDDIE N. KOJIMA ANP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 FRANK L DIGGS DR
CLINTON TN
37716-6953
US

IV. Provider business mailing address

129 FRANK L DIGGS DR
CLINTON TN
37716-6953
US

V. Phone/Fax

Practice location:
  • Phone: 865-647-3320
  • Fax: 865-647-3329
Mailing address:
  • Phone: 865-647-3320
  • Fax: 865-647-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number14675
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: