Healthcare Provider Details

I. General information

NPI: 1699706291
Provider Name (Legal Business Name): C KEITH HULSE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 KINGSTON PIKE STE 250
KNOXVILLE TN
37919-3331
US

IV. Provider business mailing address

2607 KINGSTON PIKE STE 250
KNOXVILLE TN
37919-3331
US

V. Phone/Fax

Practice location:
  • Phone: 865-264-4000
  • Fax: 865-588-6406
Mailing address:
  • Phone: 865-264-4000
  • Fax: 865-588-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP1235
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: