Healthcare Provider Details

I. General information

NPI: 1982033163
Provider Name (Legal Business Name): ROXANNE F UNDERWOOD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-8209
US

IV. Provider business mailing address

PO BOX 699
MOUNTAIN HOME TN
37684-0699
US

V. Phone/Fax

Practice location:
  • Phone: 423-930-8337
  • Fax: 423-926-1049
Mailing address:
  • Phone: 423-433-6000
  • Fax: 423-433-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17617
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: