Healthcare Provider Details

I. General information

NPI: 1457465890
Provider Name (Legal Business Name): LORETTA ROSE TURBEVILLE RN, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 VICTORIA RD
KINGSTON TN
37763-5100
US

IV. Provider business mailing address

112 VICTORIA RD
KINGSTON TN
37763-5100
US

V. Phone/Fax

Practice location:
  • Phone: 865-809-2033
  • Fax: 888-657-5448
Mailing address:
  • Phone: 865-809-2033
  • Fax: 888-657-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number63788
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12184
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: