Healthcare Provider Details

I. General information

NPI: 1982980231
Provider Name (Legal Business Name): HEALTH PARTNERS OF TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 DE ARMOND RD
KINGSTON TN
37763-6415
US

IV. Provider business mailing address

137 DE ARMOND RD
KINGSTON TN
37763-6415
US

V. Phone/Fax

Practice location:
  • Phone: 865-202-6205
  • Fax: 865-717-6676
Mailing address:
  • Phone: 865-202-6205
  • Fax: 865-717-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACEY B BURROUGHS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 865-202-6205