Healthcare Provider Details

I. General information

NPI: 1487566147
Provider Name (Legal Business Name): MICARA DESARI MINNICK BSN-RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 HIXSON PIKE
HIXSON TN
37343-3932
US

IV. Provider business mailing address

331 WARREN DR
CHATTANOOGA TN
37419-1439
US

V. Phone/Fax

Practice location:
  • Phone: 423-763-1942
  • Fax: 423-763-1842
Mailing address:
  • Phone: 423-488-4229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number283936
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: