Healthcare Provider Details

I. General information

NPI: 1073065694
Provider Name (Legal Business Name): DAVINA LEAH REPPOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E MYRTLE AVE
JOHNSONCITY TN
37601
US

IV. Provider business mailing address

1204 E MYRTLE AVE
JOHNSONCITY TN
37601
US

V. Phone/Fax

Practice location:
  • Phone: 423-218-7283
  • Fax:
Mailing address:
  • Phone: 423-218-7283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: