Healthcare Provider Details

I. General information

NPI: 1043257843
Provider Name (Legal Business Name): JOE DAVID MOTTERN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 TUSCULUM BLVD SUITE 2300
GREENEVILLE TN
37745-4286
US

IV. Provider business mailing address

6701 BAUM DR SUITE 140
KNOXVILLE TN
37919-7360
US

V. Phone/Fax

Practice location:
  • Phone: 423-823-5190
  • Fax: 423-823-5193
Mailing address:
  • Phone: 865-584-5727
  • Fax: 865-450-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN00000100379
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN6999
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: