Healthcare Provider Details

I. General information

NPI: 1144960774
Provider Name (Legal Business Name): CHRISTINA ISABELLE PATTERSON BS/RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 WALNUT AVE
JEFFERSON CITY TN
37760-1704
US

IV. Provider business mailing address

PO BOX 59019
KNOXVILLE TN
37950-9019
US

V. Phone/Fax

Practice location:
  • Phone: 865-335-6418
  • Fax:
Mailing address:
  • Phone: 865-335-6418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0000003497
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: