Healthcare Provider Details

I. General information

NPI: 1235862483
Provider Name (Legal Business Name): RAVEN J MCCARROLL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E BROADWAY BLVD
JEFFERSON CITY TN
37760-4906
US

IV. Provider business mailing address

368 YORKSHIRE CT
MORRISTOWN TN
37814-8215
US

V. Phone/Fax

Practice location:
  • Phone: 865-262-0182
  • Fax: 423-616-8363
Mailing address:
  • Phone: 865-262-0182
  • Fax: 423-616-8363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000031917
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: