Healthcare Provider Details

I. General information

NPI: 1720559479
Provider Name (Legal Business Name): RACHEL ELLEN LOVEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PROFESSIONAL PARK DR STE 21
JOHNSON CITY TN
37604-6529
US

IV. Provider business mailing address

4105 FORT HENRY DR STE 300
KINGSPORT TN
37663-2256
US

V. Phone/Fax

Practice location:
  • Phone: 434-346-3023
  • Fax: 423-926-6713
Mailing address:
  • Phone: 423-239-1538
  • Fax: 423-239-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3704
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: