Healthcare Provider Details

I. General information

NPI: 1770502551
Provider Name (Legal Business Name): JANICE F EWING FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 KNOB CREEK RD STE 102
JOHNSON CITY TN
37604-2397
US

IV. Provider business mailing address

6701 BAUM DR STE 140
KNOXVILLE TN
37919-7360
US

V. Phone/Fax

Practice location:
  • Phone: 423-794-1074
  • Fax: 423-794-1079
Mailing address:
  • Phone: 865-584-5727
  • Fax: 865-450-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71329
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6090
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: